Sympathetic Overactivity in Patients with Chronic Renal Failure

Richard L. Converse, Tage N. Jacobsen, Robert D. Toto, Charles M T Jost, Frank Cosentino, Fetnat Fouad-Tarazi, Ronald G. Victor

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Abstract

Hypertension is a frequent complication of chronic renal failure, but its causes are not fully understood. There is indirect evidence that increased activity of the sympathetic nervous system might contribute to hypertension in patients with end-stage renal disease, but sympathetic-nerve discharge has not been measured directly in patients or animals with chronic renal failure. We recorded the rate of postganglionic sympathetic-nerve discharge to the blood vessels in skeletal muscle by means of microelectrodes inserted into the peroneal nerve in 18 patients with native kidneys who were undergoing long-term treatment with hemodialysis (of whom 14 had hypertension), 5 patients receiving hemodialysis who had undergone bilateral nephrectomy (of whom 1 had hypertension), and 11 normal subjects. The mean (±SE) rate of sympathetic-nerve discharge was 2.5 times higher in the patients receiving hemodialysis who had not undergone nephrectomy than in the normal subjects (58±3 vs. 23±3 bursts per minute, P<0.01). In contrast, the rate of sympathetic-nerve discharge was similar in the patients receiving hemodialysis who had undergone bilateral nephrectomy (21±6 bursts per minute) and the normal subjects. The rate of sympathetic-nerve discharge in the patients receiving hemodialysis who had not undergone nephrectomy was also significantly higher (P<0.01) than that in the patients with bilateral nephrectomy, and it was accompanied in the former group by higher values for vascular resistance in the calf (45±4 vs. 22±4 units, P<0.05) and mean arterial pressure (106±4 vs. 76±14 mm Hg, P<0.05). The rate of sympathetic-nerve discharge was not correlated with either plasma norepinephrine concentrations or plasma renin activity. Chronic renal failure may be accompanied by reversible sympathetic activation, which appears to be mediated by an afferent signal arising in the failing kidneys. (N Engl J Med 1992;327:1912–8.), HYPERTENSION occurs in up to 80 percent of patients with chronic renal failure and is a major risk factor for the excessive cardiovascular morbidity and mortality among these patients.1 2 3 However, the underlying causes of this hypertension are not fully understood. There is indirect evidence to suggest that increased activity of the sympathetic nervous system might contribute to hypertension in patients with end-stage renal disease,4 5 6 7 8 9 10 11 12 13 but sympathetic-nerve discharge has not previously been measured directly in patients or animals with chronic renal failure. Studies in animals have indicated that the kidney is a sensory organ containing mechanically and chemically sensitive afferent nerves…

Original languageEnglish (US)
Pages (from-to)1912-1918
Number of pages7
JournalNew England Journal of Medicine
Volume327
Issue number27
DOIs
StatePublished - Dec 31 1992

ASJC Scopus subject areas

  • Medicine(all)

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    Converse, R. L., Jacobsen, T. N., Toto, R. D., Jost, C. M. T., Cosentino, F., Fouad-Tarazi, F., & Victor, R. G. (1992). Sympathetic Overactivity in Patients with Chronic Renal Failure. New England Journal of Medicine, 327(27), 1912-1918. https://doi.org/10.1056/NEJM199212313272704