This author interview is by Dr. Daniel Villareal, of SUNY Upstate Medical University. Dr. Villareal's full paper, Renal Denervation in Heart Failure: A New Therapeutic Paradigm, is available for download in Clinical Medicine Insights: Cardiology.

First please summarize for readers the content of your article.
Heart Failure is a salt avid disease with a complex and not fully understood pathophysiology. Potent neuro-humoral sodium retaining mechanisms progressively overwhelm the renal compensatory actions of the natriuretic peptides to maintain euvolemia. Through various effects on the kidney, activation of the renal sympathetic system contributes significantly to the sodium and water surfeit characteristic of cardiac decompensation. This review summarizes key studies in animal models of heart failure demonstrating that chronic afferent and efferent renal denervation promotes an enhanced natriuresis and diuresis which contributes to the re-establishment of hydro-electrolyte balance. With the recent development of minimally invasive renal denervation in humans, this novel technique may prove fundamental in the management of clinical heart failure.

How did you come to be involved in your area of study?
Our longitudinal research has investigated multiple cardio-renal mechanisms, and factors involved in the regulation of hemodynamics and sodium and water homeostasis in heart failure and hypertension. Previous studies had demonstrated that activation of the renal nerves could promote marked sodium and water retention. Accordingly, we evaluated the significance of the renal sympathetic nervous system on cardio-renal hemodynamics and renal excretory function in dog models of heart failure.

What was previously known about the topic of your article?
Earlier investigations had demonstrated that through various actions on the kidney, the renal nerves can effect significant reduction of renal hemodynamics, direct enhancement of tubular sodium reabsorption and the activation of the renin-angiotensin-aldosterone axis, all of which contribute substantially to cardio-renal dyshomeostasis in heart failure.

How was your work in the area advanced understanding of the topic?
Our longitudinal research provides important background to examine the effects of renal denervation in human heart failure through minimally invasive techniques.

What do you regard as being the most important aspect of the results reported in this article?
The available information on the beneficial actions of renal denervation in experimental heart failure should foster the design of clinical trials evaluating the potential positive therapeutic impact of renal nerve ablation in the overall care of patients with cardiac decompensation.

 

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