Kidney Res Clin Pract.  2016 Mar;35(1):3-9. 10.1016/j.krcp.2015.11.003.

Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope?

• Kiuchi MG
• Mion D

• KMID: 2161495
• DOI: http://doi.org/10.1016/j.krcp.2015.11.003

Abstract

Several studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known.

Keyword

Chronic renal insufficiency; Left ventricular hypertrophy; Sudden cardiac death; Sympathetic nervous system; Ventricular remodeling

MeSH Terms

Arrhythmias, Cardiac
Death, Sudden, Cardiac*
Heart
Heart Failure
Hope*
Humans
Hypertrophy, Left Ventricular
Kidney Diseases
Kidney Failure, Chronic
Myocardial Infarction
Renal Insufficiency
Renal Insufficiency, Chronic*
Risk Factors*
Sympathectomy
Sympathetic Nervous System
Ventricular Remodeling