Kaur Jasdeep, Young Benjamin E, Fadel Paul J
Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA.
Int J Mol Sci. 2017 Aug 2;18(8):1682. doi: 10.3390/ijms18081682.
The incidence of chronic kidney disease (CKD) is increasing worldwide, with more than 26 million people suffering from CKD in the United States alone. More patients with CKD die of cardiovascular complications than progress to dialysis. Over 80% of CKD patients have hypertension, which is associated with increased risk of cardiovascular morbidity and mortality. Another common, perhaps underappreciated, feature of CKD is an overactive sympathetic nervous system. This elevation in sympathetic nerve activity (SNA) not only contributes to hypertension but also plays a detrimental role in the progression of CKD independent of any increase in blood pressure. Indeed, high SNA is associated with poor prognosis and increased cardiovascular morbidity and mortality independent of its effect on blood pressure. This brief review will discuss some of the consequences of sympathetic overactivity and highlight some of the potential pathways contributing to chronically elevated SNA in CKD. Mechanisms leading to chronic sympathoexcitation in CKD are complex, multifactorial and to date, not completely understood. Identification of the mechanisms and/or signals leading to sympathetic overactivity in CKD are crucial for development of effective therapeutic targets to reduce the increased cardiovascular risk in this patient group.
慢性肾脏病（CKD）的发病率在全球范围内呈上升趋势，仅在美国就有超过2600万人患有CKD。死于心血管并发症的CKD患者多于进展到透析阶段的患者。超过80%的CKD患者患有高血压，这与心血管疾病发病率和死亡率的增加有关。CKD的另一个常见但可能未得到充分认识的特征是交感神经系统过度活跃。交感神经活动（SNA）的这种升高不仅导致高血压，而且在CKD进展中独立于任何血压升高发挥有害作用。事实上，高SNA与不良预后以及心血管疾病发病率和死亡率增加有关，而与其对血压的影响无关。本简要综述将讨论交感神经活动过度的一些后果，并强调一些导致CKD中SNA长期升高的潜在途径。导致CKD中慢性交感神经兴奋的机制复杂、多因素，迄今为止尚未完全了解。确定导致CKD中交感神经活动过度的机制和/或信号对于开发有效的治疗靶点以降低该患者群体增加的心血管风险至关重要。
