Sympathetic activation secondary to chronic kidney disease: therapeutic target for renal denervation?

Percutaneous ablation of the renal nerves [renal denervation (RDN)] has recently become available for treatment of (therapy-resistant) hypertension. In this review, the potential importance of RDN for patients with chronic kidney disease (CKD) is discussed. An overview of the role of the renal nerves is given, and the role of the kidneys as both generators and recipients of sympathetic hyperactivity is described. The clinical relevance of increased sympathetic nervous system activity in CKD is reviewed, and the effects of conventional treatment on sympathetic hyperactivity are summarized. Next, we present the current knowledge on the effect of RDN in CKD from both experimental and clinical studies. Finally, we discuss how this knowledge may help us in predicting the effect of RDN in hypertensive patients and ways to monitor the effect of the procedure itself.