Renal denervation: a potential new treatment modality for polycystic ovary syndrome?

Schlaich, Markus P.; Straznicky, Nora E.; Grima, Mariee; Ika-Sari, Carolina; Dawood, Tye; Mahfoud, Felix; Lambert, Elisabeth; Chopra, Reena; Socratous, Flora; Hennebry, Sarah C.; Eikelis, Nina; Böhm, Michael; Krum, Henry; Lambert, Gavin W.; Esler, Murray; Sobotka, Paul A.

doi:10.1097/hjh.0b013e328344db3a

Cited by 134 publications

(92 citation statements)

References 21 publications

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“…[15][16][17] Furthermore, additional benefits appear to be evident in patients with concomitant metabolic disorders or obstructive sleep apnea; glucose metabolism is improved and severity of sleep apnea is reduced. [18][19][20] These effects are likely to be mediated via alterations in renal afferent signaling, resulting in reductions in both renal and whole-body sympathetic outflow. 15,17 Although results from these studies are promising and the rationale to expand the use of this novel technology to hypertensive patients with moderate to severe CKD is obvious, concerns have been raised with regard to the renal safety of such an approach.…”

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confidence: 99%

Renal Denervation in Moderate to Severe CKD

Hering

Mahfoud

Walton

et al. 2012

Journal of the American Society of Nephrology

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Sympathetic activation contributes to the progression of CKD and is associated with adverse cardiovascular outcomes. Ablation of renal sympathetic nerves reduces sympathetic nerve activity and BP in patients with resistant hypertension and preserved renal function, but whether this approach is safe and effective in patients with an estimated GFR (eGFR) , 45 ml/min per 1.73 m 2 is unknown. We performed bilateral renal denervation in 15 patients with resistant hypertension and stage 3-4 CKD (mean eGFR, 31 ml/min per 1.73 m 2 ). We used CO 2 angiography in six patients to minimize exposure to contrast agents.Estimated GFR remained unchanged after the procedure, irrespective of the use of CO 2 angiography. Mean baseline BP 6 SD was 174622/91616 mmHg despite the use of 5.661.3 antihypertensive drugs. Mean changes in office systolic and diastolic BP at 1, 3, 6, and 12 months were 234/214, 225/211, 232/215, and 233/219 mmHg, respectively. Night-time ambulatory BP significantly decreased (P,0.05), restoring a more physiologic dipping pattern. In conclusion, this study suggests a favorable short-term safety profile and beneficial BP effects of catheter-based renal nerve ablation in patients with stage 3-4 CKD and resistant hypertension.

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confidence: 99%

Renal Denervation in Moderate to Severe CKD

Hering

Mahfoud

Walton

et al. 2012

Journal of the American Society of Nephrology

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324

224

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“…This includes heart failure, sleep apnoea, insulin resistance and even metabolic changes in polycystic ovary syndrome. [23][24][25][26][27] Obviously, these preliminary results have to be confirmed in larger prospective controlled trials.…”

Section: The Sympathetic Nervous Systemmentioning

confidence: 92%

Renal denervation: a new treatment option in resistant arterial hypertension

2012

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Hypertension is one of the most prevalent cardiovascular risk factors. Despite this high prevalence and a broad availability of effective pharmaceutical agents, a significant proportion of patients do not reach treatment goals. Partly this can be explained by secondary causes of hypertension or non-compliance of patients. Nevertheless, a subgroup of patients can be diagnosed with 'resistant hypertension'. Activation of the sympathetic nervous system is known to be an important factor in the development and progression of systemic hypertension. In this context, a percutaneous, catheter-based approach has been developed using radiofrequency energy to disrupt renal sympathetic nerves. The first studies have shown this technique to be safe, illustrated by a lack of vascular or renal injury. More importantly, catheter-based renal nerve ablation resulted in a significant reduction in blood pressure on top of traditional medical therapy. Additional to the encouraging effects shown on hypertension, a positive influence of this intervention in other conditions, characterised by sympathetic overactivation, may be expected. Though this technique seems promising, further studies are needed to address long-term safety and efficacy of renal denervation in hypertension and other disease states.Keywords Renal denervation . Sympathetic nervous system . Resistant hypertension . Sympathetic activity HypertensionHypertension is one of the most prevalent cardiovascular risk factors. Globally, 34 % of adults worldwide have hypertension and this number is rising.[1, 2] Despite a broad availability of effective pharmaceutical agents, only 32 % of treated men and 37 % of treated women achieve treatment goals.[3] This low success ratio can be caused by noncompliance of patients to medical therapy or secondary causes of hypertension (i.e., primary hyperaldosteronism). However, a subgroup of patients do fulfil the criteria of the phenomenon called 'resistant hypertension'. In 2008, the American Heart Association (AHA) defined resistant hypertension as a blood pressure (BP) that remains above treatment goals despite the concurrent use of medication from three different antihypertensive classes, including a diuretic, with all agents prescribed at doses that provide optimal benefit.[4] Data indicate that patients with resistant hypertension have an approximately threefold increased risk for adverse cardiovascular outcome compared with patients with well-controlled hypertension.[5] To address problems associated with a rising prevalence of (resistant) hypertension, the sympathetic nervous system (SNS) has gained renewed interest as a therapeutic target. The sympathetic nervous systemAlthough the exact pathogenesis of an elevated BP remains unclear, it has become clear that (over)activation of the SNS is an important factor in the development and progression of systemic hypertension.[6] The SNS is known to be responsible for the homeostasis mechanism of multiple organ systems. Anderson et al. measured noradrenalin spillover and muscle ...

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“…A case report of two patients suggests that patients with polycystic ovarian syndrome, which is often associated with HTN, obesity, OSA, and insulin resistance, may demonstrate better BP and glucose tolerance after RDN (11). Although these studies provide no mechanistic insight into the beneficial effects of RDN on glucose metabolism, the authors speculate that the improved insulin resistance was secondary to suppression of general sympathetic activity.…”

Section: Rdn In Insulin Resistancementioning

confidence: 97%

“…Additional findings from mostly small, uncontrolled, observational studies have suggested numerous favorable cardiovascular responses to RDN that are in need of corroboration (11)(12)(13)(14)(15)(16). The potential for early clinical adoption has also driven the development and clinical testing of multiple new devices for ablation of the perirenal sympathetic nerve fibers (17,18).…”

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confidence: 99%

Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Renal Sympathetic Denervation

Angle

Prince

Matsumoto

et al. 2014

Journal of Vascular and Interventional Radiology

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ABBREVIATIONSBP = blood pressure, CHF = congestive heart failure, HTN = hypertension, MSNA = muscle sympathetic nerve activity, NE = norepinephrine, LV = left ventricular, OSA = obstructive sleep apnea, PET = positron emission tomography, PAREPET = prediction of arrhythmic events with positron emission tomography, RCP = research consensus panel, RDN = renal denervation, RSNA = renal sympathetic nerve activity

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Renal denervation: a potential new treatment modality for polycystic ovary syndrome?

Abstract: These findings corroborate the relevance of sympathetic activation in PCOS and suggest that renal denervation exerts beneficial effects not only on blood pressure control but also on insulin sensitivity, renal, and endocrine abnormalities characteristic of PCOS.

Cited by 134 publications

References 21 publications

Renal Denervation in Moderate to Severe CKD

Renal Denervation in Moderate to Severe CKD

Renal denervation: a new treatment option in resistant arterial hypertension

Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Renal Sympathetic Denervation

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