ABSTRACT

Background: The coincidence of congestive heart failure (CHF) and chronic kidney disease (CKD) results in poor survival rate. The aim of the study was to examine if renal denervation (RDN) would improve the survival rate in CHF induced by creation of aorto-caval fistula (ACF).

Methods: Fawn-hooded hypertensive rats (FHH), a genetic model of spontaneous hypertension associated with CKD development, were used. Fawn-hooded low-pressure rats (FHL), without CKD, served as controls. RDN was performed 4 weeks after creation of ACF and the follow-up period was 10 weeks.

Results: We found that intact (non-denervated) ACF FHH exhibited survival rate of 58.8% (20 out of 34 rats), significantly lower than in intact ACF FHL (81.3%, 26/32 rats). In intact ACF FHL albuminuria remained stable throughout the study, whereas in ACF FHH it increased significantly, up to a level 40-fold higher than the basal values. ACF FHL did not show increases in renal glomerular and tubulointerstitial injury as compared with FHL, while ACF FHH exhibited marked increases in kidney injury as compared with FHH. RDN did not improve the survival rate in either ACF FHL or ACF FHH and did not alter the course of albuminuria in ACF FHL. RDN attenuated the albuminuria, but did not reduce the kidney injury in ACF FHH.

Conclusions: Our present results support the notion that even modest CKD increases CHF-related mortality. RDN did not attenuate CHF-dependent mortality in ACF FHH, it delayed the progressive rise in albuminuria, but it did not reduce the degree of kidney injury.

摘要

背景：充血性心力衰竭 (CHF) 和慢性肾病 (CKD) 的同时发生导致生存率低。该研究的目的是检查去肾神经支配 (RDN) 是否会提高主动脉腔静脉瘘 (ACF) 诱导的 CHF 的存活率。

方法：使用小鹿头巾高血压大鼠 (FHH)，一种与 CKD 发展相关的自发性高血压遗传模型。没有 CKD 的小鹿头巾低压大鼠 (FHL) 作为对照。RDN 在创建 ACF 后 4 周进行，随访期为 10 周。

结果：我们发现完整（非去神经支配）ACF FHH 的存活率为 58.8%（34 只大鼠中的 20 只），显着低于完整 ACF FHL（81.3%，26/32 只大鼠）。在完整的 ACF FHL 中，蛋白尿在整个研究过程中保持稳定，而在 ACF FHH 中，它显着增加，高达基础值的 40 倍。与 FHL 相比，ACF FHL 未显示肾小球和肾小管间质损伤增加，而 ACF FHH 与 FHH 相比，肾损伤显着增加。RDN 没有提高 ACF FHL 或 ACF FHH 的存活率，也没有改变 ACF FHL 的蛋白尿病程。RDN 减弱了蛋白尿，但没有减少 ACF FHH 的肾损伤。

结论：我们目前的结果支持即使是轻度 CKD 也会增加 CHF 相关死亡率的观点。RDN 没有降低 ACF FHH 中 CHF 依赖性死亡率，它延迟了蛋白尿的进行性升高，但没有降低肾损伤程度。