柴东剑,徐红青,吴叶顺

• 1:衢州市人民医院心内科

摘要(Abstract)：

交感神经系统的过度激活会促进高血压合并慢性肾脏病（CKD）患者的疾病进展，导致血压升高并加速肾功能恶化。经皮去肾神经术（RDN）是一种通过导管消融肾动脉周围交感神经的介入疗法，其作用机制在于减少肾交感神经活性，从而降低血压，改善肾脏血流动力学。近年来，多项研究探索了RDN在高血压合并CKD患者中的应用价值，提示该技术在控制难治性高血压的同时可能对肾功能产生一定的保护作用。本文旨在系统梳理交感神经激活在高血压合并CKD进展中的作用机制，回顾RDN在该人群中的最新研究进展与临床应用，并对其未来在个体化治疗和延缓肾脏病进展中的潜力进行展望。

关键词(KeyWords)： 经皮去肾神经术;高血压;慢性肾脏病;交感神经系统;蛋白尿;估算的肾小球滤过率

Abstract:

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基金项目(Foundation):

作者(Author): 柴东剑,徐红青,吴叶顺

参考文献(References)：

• [1] Mahmoodi BK,Matsushita K,Woodward M,et al.Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension:a meta-analysis[J].Lancet,2012,380(9854):1649-1661.DOI:10.1016/S0140-6736(12)6272-0
• [2] Tanner RM,Calhoun DA,Bell EK,et al.Prevalence of apparent treatment-resistant hypertension among individuals with CKD[J].Clin J Am Soc Nephrol,2013,8(9):1583-1590.DOI:10.2215/CJN.00550113.
• [3]Mozaffarian D,Benjamin EJ,Go AS,et al.Heart disease and stroke statistics--2015 update:a report from the American Heart Association[J].Circulation,2015,131(4):e29-e322.DOI:10.1161/CIR.0000000000000152.
• [4]GBD Chronic Kidney Disease Collaboration.Global,regional,and national burden of chronic kidney disease,1990-2017:a systematic analysis for the Global Burden of Disease Study2017[J].Lancet,2020,395(10225):709-733.DOI:10.1016/S0140-6736(20)30045-3.
• [5]DiBona GF,Kopp UC.Neural control of renal function[J].Physiol Rev,1997,77(1):75-197.DOI:10.1152/physrev.1997.77.1.75.
• [6]Hausberg M,Kosch M,Harmelink P,et al.Sympathetic nerve activity in end-stage renal disease[J].Circulation,2002,106(15):1974-1979.DOI:10.1161/01.cir.0000034043.16664.96.
• [7]Grassi G,Quarti-Trevano F,Seravalle G,et al.Early sympathetic activation in the initial clinical stages of chronic renal failure[J].Hypertension,2011,57(4):846-851.DOI:10.1161/HYPERTENSIONAHA.110.164780.
• [8]Ott C,Schmid A,Ditting T,et al.Effects of renal denervation on blood pressure in hypertensive patients with end-stage renal disease:a single centre experience[J].Clin Exp Nephrol,2019,23(6):749-755.DOI:10.1007/s10157-019-01697-7.
• [9]国家放射与治疗临床医学研究中心,苏州工业园区东方华夏心血管健康研究院高血压介入治疗工作委员会,《经皮去肾神经术治疗高血压临床路径中国专家共识(2025版)》专家组.经皮去肾神经术治疗高血压临床路径中国专家共识(2025版)[J].中国介入心脏病学杂志,2025,33(9):481-490.DOI:10.3969/j.issn.1004-8812.2025.09.001.
• [10]苏州工业园区东方华夏心血管健康研究院高血压介入治疗工作委员会,《经皮去肾神经术治疗高血压中国专家科学声明》专家组.经皮去肾神经术治疗高血压中国专家科学声明[J].中国介入心脏病学杂志,2023,31(12):881-893.DOI:10.3969/j.issn.1004-8812.2023.12.001.
• [11] B??hm M,Ewen S,Linz D,et al.Renal denervation:a novel non-pharmacological approach in heart failure[J].J Cardiovasc Transl Res,2014,7(3):330-337.DOI:10.1007/s12265-014-9549-5.
• [12]Sobotka PA,Mahfoud F,Schlaich MP,et al.Sympatho-renal axis in chronic disease[J].Clin Res Cardiol,2011,100(12):1049-1057.DOI:10.1007/s00392-011-0335-y.
• [13]F reeman WD,Wadei HM.A brain-kidney connection:the delicate interplay of brain and kidney physiology[J].Neurocrit Care,2015,22(2):173-175.DOI:10.1007/s 12028-015-0119-8.
• [14] Kiuchi MG,Esler MD,Fink GD,et al.Renal denervation update from the international sympathetic nervous system summit:JACC state-of-the-art review[J].J Am Coll Cardiol,2019,73(23):3006-3017.DOI:10.1016/j.jacc.2019.04.015.
• [15] Mazza A,Dell'Avvocata F,Torin G,et al.Does renal denervation a reasonable treatment option in hemodialysis-dependent patient with resistant hypertension?A narrative review[J].Curr Hypertens Rep,2023,25(11):353-363.DOI:10.1007/s11906-023-01264-2.
• [16] Ott C,Mahfoud F,Mancia G,et al.Renal denervation in patients with versus without chronic kidney disease:results from the Global SYMPLICITY Registry with follow-up data of3 years[J].Nephrol Dial Transplant,2022,37(2):3 04-310.DOI:10.1093/ndt/gfab154.
• [17]Singh RR,McArdle ZM,Booth LC,et al.Increase in bioavailability of nitric oxide after renal denervation improves kidney function in sheep with hypertensive kidney disease[J].Hypertension,2021,77(4):1299-1310.DOI:10.1161/HYPERTENSIONAHA.120.16718.
• [18]Singh RR,McArdle ZM,Iudica M,et al.S u sta i ne d decrease in blood pressure and reduced anatomical and functional reinnervation of renal nerves in hypertensive sheep 30 months after catheter-based renal denervation[J].Hypertension,2019,73(3):718-727.DOI:10.1161/HYPERTENSIONAHA.118.12250.
• [19]Schlaich MP,Bart B,Hering D,et al.Feasibility of catheterbased renal nerve ablation and effects on sympathetic nerve activity and blood pressure in patients with end-stage renal disease[J].Int J Cardiol,2013,168(3):2214-2220.DOI:10.1016/j.ijcard.2013.01.218.
• [20] Hering D,Marusic P,Duval J,et al.Effect of renal denervation on kidney function in patients with chronic kidney disease[J].Int J Cardiol,2017,232:93-97.DOI:10.1016/j.ijcard.2017.01.047.
• [21]Liu SH,Lo LW,Chou YH,et al.Renal denervation prevents myocardial structural remodeling and arrhythmogenicity in a chronic kidney disease rabbit model[J].HeartRhythm,2021,18(9):1596-1604.DOI:10.1016/j.hrthm.2021.05.014.
• [22]Lubanda JC,Chochola M,Mlcek M,et al.The effect of renal denervation in an experimental model of chronic renal insufficiency,the remnant kidney denervation in pigs study(REDIP study)[J].J Transl Med,2017,15(1):215.DOI:10.1186/s 12967-017-1319-0.
• [23]Wu LL,Zhang Y,Li XZ,et al.Impact of selective renal afferent denervation on oxidative stress and vascular remodeling in spontaneously hypertensive rats[J].Antioxidants(Basel),2022,11(5):1003.DOI:10.3390/antiox11051003.
• [24] B??hner AMC,Jacob AM,Heuser C,et al.Renal denervation exacerbates LPS-and antibody-induced acute kidney injury,but protects from pyelonephritis in mice[J].J Am Soc Nephrol,2021,32(10):2445-2453.DOI:10.1681/ASN.2021010110.
• [25] B??hm M,Kario K,Kandzari DE,et al.Efficacy of catheter-based renal denervation in the absence of antihypertensive medications(SPYRAL HTN-OFF MED Pivotal):a multicentre,randomised,sham-controlled trial[J].Lancet,2020,395(10234):1444-1451.DOI:10.1016/S0140-6736(20)30554-7.
• [26] Kandzari DE,Townsend RR,Kario K,et al.Safety and efficacy of renal denervation in patients taking antihypertensive medications[J].J Am Coll Cardiol,2023,82(19):1809-1823.DOI:10.1016/j.j acc.2023.08.045.
• [27]B??hm M,Mahfoud F,Ukena C,et al.First report of the Global SYMPLICITY Registry on the effect of renal artery denervation in patients with uncontrolled hypertension[J].Hypertension,2015,65(4):766-774.DOI:10.1161/HYPERTENSIONAHA.114.05010.
• [28]Soleimani H,Sattartabar B,Parastooei B,et al.Renal denervation effects on blood pressure in resistant and uncontrolled hypertension:a meta-analysis of sham-controlled randomized clinical trials[J].Clin Cardiol,2025,48(3):e70104.DOI:10.1002/clc.70104.
• [29]Mohammad A A,Nawar K,Binks O,et al.Effects of renal denervation on kidney function in patients with chronickidney disease:a systematic review and meta-analysis[J].J Hum Hypertens,2024,38(1):29-44.DOI:10.1038/s41371-023-00857-3.
• [30]Xia M,Liu T,Chen D,et al.Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease:a meta-analysis[J].Int J Hyperthermia,2021,38(1):732-742.DOI:10.1080/02656736.2021.1916100.
• [31]Liu S,Bian R,Qian Y,et al.Catheter-based renal denervation in Chinese patients with chronic kidney disease and uncontrolled hypertension[J].J Clin Hypertens(Greenwich),2023,25(1):71-77.DOI:10.1111/jch.14605.
• [32]Scalise F,Sole A,Singh G,et al.Renal denervation in patients with end-stage renal disease and resistant hypertension on long-term haemodialysis[J].J Hypertens,2020,38(5):936-942.DOI:10.1097/HJH.00000000000023 58.
• [33] Ott C,Mahfoud F,Schmid A,et al.Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension[J].J Hypertens,2015,33(6):1261-1266.DOI:10.1097/HJH.0000000000000556.
• [34]Kiuchi MG,Graciano ML,Carreira MA,et al.Long-term effects of renal sympathetic denervation on hypertensive patients with mild to moderate chronic kidney disease[J].J Clin Hypertens(Greenwich),2016,18(3):190-196.DOI:10.1111/jch.12724.
• [35]Jones DW,Ferdinand KC,Taler SJ,et al.2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/A SPC/NMA/PCNA/SGIM guideline for the prevention,detection,evaluation,and management of high blood pressure in adults:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].J Am Coll Cardiol,2025,86(18):1567-1678.DOI:10.1016/j.jacc.2025.05.007.
• [36]McEvoy JW,McCarthy CP,Bruno RM,et al.2024 ESC guidelines for the management of elevated blood pressure and hypertension[J].Eur Heart J,2024,45(38):3912-4018.DOI:10.1093/eurheartj/ehae178.