Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
EuroIntervention. 2013 May;9 Suppl R:R127-35. doi: 10.4244/EIJV9SRA22.
The prevalence of chronic kidney disease (CKD) and end-stage renal disease continues to increase worldwide. Hypertension and diabetes are recognised as two major factors contributing to further progression of CKD. Importantly, progressive renal impairment increases cardiovascular morbidity and mortality. Despite advances in pharmacological antihypertensive and anti-diabetic approaches, the alarming number of patients developing nephropathy indicates the failure of the available treatment strategies. The relevance of sympathetic activation for the development and progression of chronic kidney disease is well established. Likewise, progressive renal failure results in exaggerated sympathetic activation leading to a vicious cycle, providing the rationale for the use of renal denervation to modulate directly the mechanisms underlying disease progression. While initial data on the safety and effectiveness of the procedure to lower BP were obtained in patients with resistant hypertension and preserved renal function, there are now preliminary data to suggest that this approach can also be applied safely in patients with stage 3-4 CKD. Similarly, first reports applying renal denervation in patients with end-stage renal disease on dialysis demonstrate favourable effects. If appropriately designed clinical trials can confirm these initial observations, renal denervation may become a valuable new treatment option for the large cohort of patients with CKD.
慢性肾脏病（CKD）和终末期肾病的患病率在全球范围内持续上升。高血压和糖尿病被认为是导致 CKD 进一步进展的两个主要因素。重要的是，肾功能的进行性损害会增加心血管发病率和死亡率。尽管在降压和降糖的药理学治疗方面取得了进展，但仍有大量患者发生肾病，这表明现有的治疗策略失败了。交感神经激活与慢性肾脏病的发生和进展密切相关。同样，进行性肾功能衰竭会导致交感神经激活加剧，形成恶性循环，这为使用肾去神经术直接调节疾病进展的机制提供了依据。虽然最初的数据表明，该手术可安全有效地降低血压，适用于血压难以控制且肾功能正常的患者，但现在有初步数据表明，这种方法在 3-4 期 CKD 患者中也可安全应用。同样，对接受透析的终末期肾病患者应用肾去神经术的初步报告显示出有益的效果。如果精心设计的临床试验能够证实这些初步观察结果，那么肾去神经术可能成为 CKD 这一大患者群体的一种有价值的新治疗选择。
