Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 57; no. 4; pp. 846 - 851
• Main Authors: Grassi, Guido, Quarti-Trevano, Fosca, Seravalle, Gino, Arenare, Francesca, Volpe, Marco, Furiani, Silvia, DellʼOro, Raffaella, Mancia, Giuseppe
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.04.2011; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Arterial hypertension. Arterial hypotension; Baroreflex - physiology; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Chromatography, High Pressure Liquid; Electrocardiography; Female; Fundamental and applied biological sciences. Psychology; Heart Rate - physiology; Humans; Hypertension - blood; Hypertension - complications; Hypertension - physiopathology; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Male; Medical sciences; Middle Aged; Norepinephrine - blood; Sympathetic Nervous System - physiopathology; Vertebrates: urinary system; Kidney disease; Hypertension; Urinary system disease; chronic renal failure; microneurography; Renal failure; Cardiovascular disease; Sympathetic nervous system
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.110.164780

Direct and indirect indices of neuroadrenergic function have shown that end-stage renal disease is characterized by a marked sympathetic overdrive. It is unknown, however, whether this phenomenon represents a peculiar feature of end-stage renal disease or whether it is also detectable in the early clinical phases of the disease. The study has been performed in 73 hypertensive patients, of which there were 42 (age60.7±1.8 years, mean±SEM) with a stable moderate chronic renal failure (mean estimated glomerular filtration rate40.7 mL/min per 1.73 m, MDRD formula) and 31 age-matched controls with a preserved renal function. Measurements included anthropometric variables, sphygmomanometric and beat-to-beat blood pressure, heart rate (ECG), venous plasma norepinephrine (high-performance liquid chromatography), and efferent postganglionic muscle sympathetic nerve activity (microneurography, peroneal nerve). For similar anthropometric and hemodynamic values, renal failure patients displayed muscle sympathetic nerve activity values significantly and markedly greater than controls (60.0±2.1 versus 45.7±2.0 bursts per 100 heartbeats; P<0.001). Muscle sympathetic nerve activity showed a progressive and significant increase from the first to the fourth quartile of the estimated glomerular filtration rate values (first41.0±2.7; second51.9±1.7; third59.8±3.0; fourth61.9±3.3 bursts per 100 heartbeats), the statistical significance (P<0.05) between groups being maintained after adjustment for confounders. In the population as a whole, muscle sympathetic nerve activity was significantly and inversely correlated with the estimated glomerular filtration rate (r=−0.59; P<0.0001). Thus, adrenergic activation is a phenomenon not confined to advanced renal failure but already detectable in the initial phases of the disease. The sympathetic overdrive parallels the severity of the renal failure, state and, thus, it might participate, in conjunction with other factors, at the disease progression.