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Cited by 46Blood Pressure and Hypertension StudiesRenin-Angiotensin System StudiesHeart Rate Variability and Autonomic Control

Renal nerves in physiology, pathophysiology and interoception

Open access
Evans, Louise C., Dayton, Alex, Osborn, John W.·2025·Nature Reviews Nephrology
DOI 10.1038/s41581-024-00893-3PMC PMC13539610
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Abstract

Sympathetic efferent renal nerves have key roles in the regulation of kidney function and blood pressure. Increased renal sympathetic nerve activity is thought to contribute to hypertension by promoting renal sodium retention, renin release and renal vasoconstriction. This hypothesis led to the development of catheter-based renal denervation (RDN) for the treatment of hypertension. Two RDN devices that ablate both efferent and afferent renal nerves received FDA approval for this indication in 2023. However, in animal models, selective ablation of afferent renal nerves resulted in comparable anti-hypertensive effects to ablation of efferent and afferent renal nerves and was associated with a reduction in sympathetic nerve activity. Selective afferent RDN also improved kidney function in a chronic kidney disease model. Notably, the beneficial effects of RDN extend beyond hypertension and chronic kidney disease to other clinical conditions that are associated with elevated sympathetic nerve activity, including heart failure and arrhythmia. These findings suggest that the kidney is an interoceptive organ, as increased renal sensory nerve activity modulates sympathetic activity to other organs. Future studies are needed to translate this knowledge into novel therapies for the treatment of hypertension and other cardiorenal diseases.

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Crossref · 10.1038/s41581-024-00893-3

Cites

165 of 165 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

48 of 157 cited sources checked · 25 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    A 2023 study found that renal nerve density was highest in proximal arterial segments and fell progressively toward distal post-bifurcation segments.

    “A 2023 study that characterized the distribution of renal nerves along the renal arteries found that the density of nerves was highest in the proximal segments and decreased progressively along the length of the arteries to the distal post-bifurcation segments35.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [35] Struthoff, H. et al. Histological examination of renal nerve distribution, density, and function in humans. EuroIntervention 19, 612–620 (2023). source

      The 'NERVE NUMBER DENSITY PER ANALYSED AREA' section reports the opposite pattern: density was lowest proximally (54.0 nerves/cm²) and highest in distal post-bifurcation segments (70.9 nerves/cm²). The Discussion distinguishes density from the number of nerves per quadrant, which did decrease from proximal to distal. Page numbers are not provided in our copy. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Preclinical studies have identified a previously underappreciated role of afferent renal nerves in hypertension and chronic kidney disease.

    “Preclinical studies have now identified a previously underappreciated role of afferent renal nerves in the development of hypertension and chronic kidney disease (CKD)5,20–22.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [5] Ong, J. et al. Renal sensory nerves increase sympathetic nerve activity and blood pressure in 2-kidney 1-clip hypertensive mice. J. Neurophysiol. 122, 358–367 (2019). source
    • cites [20] Lauar, M. R. et al. Renal and hypothalamic inflammation in renovascular hypertension: role of afferent renal nerves. Am. J. Physiol. Regul. Integr. Comp. Physiol. 325, R411–R422 (2023). source
    • cites [21] Veiga, A. C. et al. Selective afferent renal denervation mitigates renal and splanchnic sympathetic nerve overactivity and renal function in chronic kidney disease-induced hypertension. J. Hypertens. 38, 765–773 (2020). source
    • cites [22] Banek, C. T. et al. Resting afferent renal nerve discharge and renal inflammation: elucidating the role of afferent and efferent renal nerves in deoxycorticosterone acetate salt hypertension. Hypertension 68, 1415–1423 (2016). source

      The Discussion (page not available in our copy) concludes that afferent renal nerves contribute to the development of DOCA-salt hypertension in rats. It also discusses hypertension following renal injury and in chronic renal failure, but does not establish a role for afferent nerves in the development of chronic kidney disease itself. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The reductions in MSNA and the benefits of renal denervation in heart failure and arrhythmia cannot be fully explained by changes in body fluid balance.

    “However, RDN-induced reductions in MSNA18 and beneficial effects of RDN on conditions that are not traditionally thought to be driven by the kidney, including heart failure and arrthymia19, cannot be wholly explained by alterations in body fluid homeostasis.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] Schlaich, M. P., Sobotka, P. A., Krum, H., Lambert, E. & Esler, M. D. Renal sympathetic-nerve ablation for uncontrolled hypertension. N. Engl. J. Med. 361, 932–934 (2009). source
    • cites [19] Kassab, K., Soni, R., Kassier, A. & Fischell, T. A. The potential role of renal denervation in the management of heart failure. J. Clin. Med. 11, 4147 (2022). source
  • Findingown data

    About half of mouse kidney glomeruli are associated with sensory nerve fibres that often wrap around Bowman's capsule before continuing to another glomerulus or cortical target.

    “Our studies demonstrated that approximately half of the glomeruli in the mouse kidney are associated with sensory nerve fibres that often wrap around Bowman’s capsule before continuing to another glomerulus or other cortical target34.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [34] Tyshynsky, R. et al. Periglomerular afferent innervation of the mouse renal cortex. Front. Neurosci. 17, 974197 (2023). source

      The Abstract reports that approximately half of sampled mouse glomeruli were closely apposed to afferent axons. Results §3.2 and Discussion §4.1 describe axons traveling near the presumed surface of Bowman’s capsule, while Results §3.3 shows bundles approaching multiple glomeruli. The paper does not establish that individual fibres commonly wrap around the capsule and then continue to another glomerulus or cortical target; it says shared sensory innervation remains to be determined. Page numbers were not available in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Plasma renin activity predicts how well renal denervation works in patients with hypertension.

    “Plasma renin activity is predictive of the efficacy of RDN in patients with hypertension40, suggesting a key role of this pathway in the development of the disease.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] Mahfoud, F. et al. Changes in plasma renin activity after renal artery sympathetic denervation. J. Am. Coll. Cardiol. 77, 2909–2919 (2021). source

      The Conclusions report that higher baseline plasma renin activity was associated with greater blood-pressure reduction after renal denervation. The Discussion says it could predict response, but the finding was in patients not taking antihypertensive medication, and the authors say the optimal predictive cutoff still needs prospective determination. The claim presents prediction more definitively and broadly than the paper does. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • May combine two claims. 50
  • Classified as probably not a substantial claim. 5
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    In 2023, clinical adoption of renal denervation was recommended by guidelines from the International Society of Hypertension and the European Renal Association, and from the European Society of Cardiology Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions.

    “clinical adoption of RDN was recommended in 2023 guidelines from the International Society of Hypertension and the European Renal Association15, and from the European Society of Cardiology Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions16,17”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [15] Mancia, G. et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J. Hypertension 41, 1874–2071 (2023). source
    • cites [16] Barbato, E. et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 44, 1313–1330 (2023). source

      The Introduction (p. 2) identifies this 2023 paper as a clinical consensus document of the ESC Council on Hypertension and EAPCI, and Centre selection (p. 9) recommends teams to evaluate indications for and perform renal denervation. Calling it a guideline recommending general clinical adoption overstates the source: it gives conditional consensus statements about patient selection and centre requirements. The International Society of Hypertension and European Renal Association portion is attached to a different citation and is not assessed here. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [17] Barbato, E. et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EuroIntervention 18, 1227–1243 (2023). source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The rise in afferent activity after intra-pelvic hypertonic saline can be blocked by benzamil or amiloride, suggesting a link between pelvic ENaC activity and afferent renal nerve activation.

    “afferent activity after intra-pelvic infusion of hypertonic saline can be blocked by simultaneous infusion of benzamil or amiloride, which block the epithelial sodium channel (ENaC)54, suggesting a link between pelvic ENaC activity and the activation of afferent renal nerves.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [54] Goodwill, V. S., Terrill, C., Hopewood, I., Loewy, A. D. & Knuepfer, M. M. CNS sites activated by renal pelvic epithelial sodium channels (ENaCs) in response to hypertonic saline in awake rats. Auton. Neurosci. 204, 35–47 (2017). source

      Results §3.2 reports that hypertonic saline increased afferent renal nerve activity in anesthetized rats and that simultaneous benzamil or amiloride significantly attenuated the increase. It does not report complete blockade of the nerve response, so “blocked” overstates the result. The Discussion (§4.4) also notes that these drugs can affect sodium sensors other than ENaC. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Afferent renal nerves are chemosensitive, and their activity increases after intra-pelvic or intra-arterial infusion of adenosine, bradykinin, substance P, prostaglandin E2 or hypertonic saline.

    “Afferent renal nerves are chemosensitive and increases in activity have been documented in response to both intra-pelvic and intra-arterial infusion of adenosine, bradykinin, substance P, prostaglandin E2 and hypertonic saline45,50–54.”
    Quote in the paperNot a substantial claim1 of 6 sources checked
    • cites [45] Ma, M. C., Huang, H. S., Wu, M. S., Chien, C. T. & Chen, C. F. Impaired renal sensory responses after renal ischemia in the rat. J. Am. Soc. Nephrol. 13, 1872–1883 (2002). source
    • cites [50] Katholi, R. E., Whitlow, P. L., Hageman, G. R. & Woods, W. T. Intrarenal adenosine produces hypertension by activating the sympathetic nervous system via the renal nerves in the dog. J. Hypertens. 2, 349–359 (1984). source
    • cites [51] Smits, J. F. & Brody, M. J. Activation of afferent renal nerves by intrarenal bradykinin in conscious rats. Am. J. Physiol. 247, R1003–R1008 (1984). source
    • cites [52] Kopp, U. C. et al. Activation of EP4 receptors contributes to prostaglandin E2-mediated stimulation of renal sensory nerves. Am. J. Physiol. Renal Physiol. 287, F1269–F1282 (2004). source
    • cites [53] Zhu, Y., Xie, C. & Wang, D. H. TRPV1-mediated diuresis and natriuresis induced by hypertonic saline perfusion of the renal pelvis. Am. J. Nephrol. 27, 530–537 (2007). source
    • cites [54] Goodwill, V. S., Terrill, C., Hopewood, I., Loewy, A. D. & Knuepfer, M. M. CNS sites activated by renal pelvic epithelial sodium channels (ENaCs) in response to hypertonic saline in awake rats. Auton. Neurosci. 204, 35–47 (2017). source

      The Introduction describes renal afferent fibers as chemosensitive, and Results §3.2 reports increased afferent nerve activity after hypertonic saline was infused into the renal pelvis of anesthetized rats. The paper does not document increased activity after intra-arterial infusion or after infusion of adenosine, bradykinin, substance P, or prostaglandin E2. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Renal denervation has shown promise for pain from loin pain haematuria syndrome, polycystic kidney disease and renal colic after recurrent kidney stones.

    “RDN has shown promise in the treatment of pain resulting from loin pain haematuria syndrome58, polycystic kidney disease59,60 and renal colic after recurrent kidney stones61.”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [58] Prasad, B., Giebel, S., Garcia, F., Goyal, K. & St Onge, J. R. Renal denervation in patients with loin pain hematuria syndrome. Am. J. Kidney Dis. 69, 156–159 (2017). source
    • cites [59] de Jager, R. L. et al. Catheter-based renal denervation as therapy for chronic severe kidney-related pain. Nephrol. Dial. Transpl. 33, 614–619 (2018). source
    • cites [60] Casteleijn, N. F., de Jager, R. L., Neeleman, M. P., Blankestijn, P. J. & Gansevoort, R. T. Chronic kidney pain in autosomal dominant polycystic kidney disease: a case report of successful treatment by catheter-based renal denervation. Am. J. Kidney Dis. 63, 1019–1021 (2014). source
    • cites [61] Reed, A., Cho, D., Gillcrist, N. & Allam, C. Laparoscopic renal denervation for chronic renal colic in a previous stone forming patient. Urol. Case Rep. 19, 13–15 (2018). source

  • May combine two claims.

    Premisecitation

    cAMP pathway activation increases renin production and release, activates the renin-angiotensin system, and raises blood pressure.

    “Activation of the cAMP pathway results in increased production and release of renin, activation of the renin–angiotensin system and a subsequent increase in blood pressure39.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [39] Persson, P. B. Renin: origin, secretion and synthesis. J. Physiol. 552, 667–671 (2003). source

  • May combine two claims.

    Premisecitation

    In a follow-up analysis of SPYRAL HTN ON MED, patients enrolled outside the USA had a significant systolic blood pressure reduction with renal denervation but no change in medication burden, whereas patients enrolled in the USA had reduced medication burden but no blood pressure reduction.

    “Among patients enrolled outside the USA, RDN caused a significant reduction in SBP but did not alter medication burden. By contrast, among patients enrolled in the USA, medication burden but not blood pressure was reduced with RDN.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [91] Townsend, R. R. et al. Impact of antihypertensive medication changes after renal denervation among different patient groups: SPYRAL HTN-ON MED. Hypertension 81, 1095–1105 (2024). source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the RADIANCE trials, renal denervation lowered blood pressure compared with sham, producing an approximately 6-mmHg decrease in daytime ambulatory systolic blood pressure.

    “In all three trials, RDN reduced blood pressure relative to a sham procedure, resulting in an approximately 6-mmHg decrease in daytime ambulatory SBP.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [12] Azizi, M. et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet 391, 2335–2345 (2018). source

      The Results report a 6.3-mmHg greater reduction in daytime ambulatory systolic blood pressure with renal denervation than with sham at 2 months, supporting the approximate 6-mmHg comparison. This paper reports the RADIANCE-HTN SOLO trial, however, and does not establish the claim about all three trials. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [87] Azizi, M. et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet 397, 2476–2486 (2021). source
    • cites [88] Azizi, M. et al. Endovascular ultrasound renal denervation to treat hypertension: the radiance ii randomized clinical trial. JAMA 329, 651–661 (2023). source

      The Results (p. 6) report a 6.3-mm Hg greater reduction in daytime ambulatory systolic blood pressure with renal denervation than with sham in RADIANCE II. The Discussion (p. 13) reports the same 6.3-mm Hg difference for RADIANCE-HTN SOLO. Our copy identifies RADIANCE-HTN TRIO but does not establish an approximately 6-mm Hg difference for that third trial, so the claim about all three is not fully supported. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    About 10-15% of patients with hypertension have resistant hypertension, defined as high blood pressure that does not respond to three antihypertensives from different classes including a diuretic.

    “Approximately 10–15% of patients with hypertension are categorized as having resistant hypertension, which is defined as high blood pressure that fails to respond to concurrent administration of three antihypertensives from different classes, including a diuretic66.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [66] Yaxley, J. P. & Thambar, S. V. Resistant hypertension: an approach to management in primary care. J. Fam. Med. Prim. Care 4, 193–199 (2015). source

      The Introduction defines resistant hypertension as blood pressure above 140/90 mmHg despite three antihypertensives of different classes at the best tolerated doses, including a diuretic. The Epidemiology section estimates approximately 10% of hypertensive patients in westernised countries, not a 10–15% range for patients with hypertension generally. Page numbers are not provided in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Around 40% of patients with chronic kidney disease have resistant hypertension, which does not respond to standard treatments.

    “Around 40% of patients with CKD have resistant hypertension103, which does not respond to standard treatments.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [103] Thomas, G. et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the chronic renal insufficiency cohort study. Hypertension 67, 387–396 (2016). source

      The Results report apparent treatment-resistant hypertension in 40.4% of hypertensive participants in the CRIC cohort, not 40% of all patients with CKD. They also report that 47.5% of those classified as having it had blood pressure at goal on four or more medications, so the claim that it does not respond to treatment does not describe the whole group. The source calls the condition 'apparent' because it could not exclude causes of apparent resistance. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The anti-hypertensive effects of afferent renal denervation are not universal; Dahl salt-sensitive rats and stroke-prone spontaneously hypertensive rats do not respond to afferent renal denervation but do respond to total renal denervation.

    “The anti-hypertensive effects of ARDN are not ubiquitous and several models such as the Dahl salt-sensitive rat77 and the stroke-prone spontaneously hypertensive rat78 do not respond to this intervention but do show anti-hypertensive responses to TRDN77,78.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [77] Foss, J. D., Fink, G. D. & Osborn, J. W. Differential role of afferent and efferent renal nerves in the maintenance of early- and late-phase Dahl S hypertension. Am. J. Physiol. Regul. Integr. Comp. Physiol. 310, R262–R267 (2016). source
    • cites [78] Ikeda, S. et al. Contribution of afferent renal nerve signals to acute and chronic blood pressure regulation in stroke-prone spontaneously hypertensive rats. Hypertens. Res. 46, 268–279 (2023). source

  • May combine two claims.

    Premisecitation

    Elevated sympathetic nerve activity is a hallmark of chronic kidney disease that is evident even in early stages and correlates inversely with estimated glomerular filtration rate and disease progression.

    “Elevated sympathetic nerve activity is a hallmark of CKD104 that is evident even in the early stages of the disease and correlates inversely with estimated glomerular filtration rate (eGFR) and disease progression105.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [104] Kaur, J., Young, B. E. & Fadel, P. J. Sympathetic overactivity in chronic kidney disease: consequences and mechanisms. Int. J. Mol. Sci. 18, 1682 (2017). source
    • cites [105] Grassi, G. et al. Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension 57, 846–851 (2011). source

  • May combine two claims.

    Premisecitation

    In a swine model, renal denervation significantly reduced the inducibility of atrial fibrillation and the duration of induced atrial fibrillation episodes immediately after denervation.

    “A study in a swine model in which the renal nerves were surgically ablated using a laparoscopic procedure found that RDN significantly reduced the inducibility of atrial fibrillation (OR = 0.32) and the duration of induced atrial fibrillation episodes (from 28 s to 7 s)161. Importantly, these findings were observed immediately after denervation, indicating that the effects of RDN on atrial”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [161] Kwon, S. et al. Novel laparoscopic renal denervation immediately reduces atrial fibrillation inducibility: a swine model study. Sci. Rep. 13, 19679 (2023). source

  • May combine two claims.

    Premisecitation

    A 2024 case report of ultrasound renal denervation in a patient with heart failure with preserved ejection fraction found a substantial reduction in estimated stressed blood volume at 6 months and an improvement in cardiac sympathetic nerve activity at 18 months after the procedure.

    “A 2024 case report of ultrasound RDN in a patient with HFpEF found a substantial reduction in estimated stressed blood volume at 6 months and an improvement in cardiac sympathetic nerve activity at 18 months after the procedure152.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [152] Shiraki, T. et al. Cardiac sympathetic nerve activity trends after renal denervation in heart failure with preserved ejection fraction. ESC Heart Fail. 11, 2426–2431 (2024). source

  • May combine two claims.

    Premisecitation

    A review and meta-analysis of 11 clinical trials of renal denervation in heart failure with reduced ejection fraction concluded that the procedure improves left ventricular ejection fraction and increases 6-min walk distance, independent of reductions in blood pressure and changes in estimated glomerular filtration rate and creatinine levels.

    “A review and meta-analysis146 of the 11 clinical trials of RDN in patients with HFrEF conducted to date concluded that the procedure improves LVEF and increases the 6-min walk distance in this population. These beneficial effects were independent of reductions in blood pressure and changes in eGFR and creatinine levels.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [146] Li, M. et al. Renal denervation in management of heart failure with reduced ejection fraction: a systematic review and meta-analysis. J. Cardiol. 81, 513–521 (2023). source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the ERADICATE-AF trial, patients with hypertension and paroxysmal atrial fibrillation who underwent pulmonary vein isolation plus radiofrequency renal denervation had higher freedom from atrial arrhythmia at 12 months and greater reduction in systolic blood pressure than those who underwent pulmonary vein isolation alone.

    “At 12 months, 56.5% of the participants who underwent PVI alone versus 72.1% of those who underwent PVI plus RDN were free from atrial arrhythmia (hazard ratio 0.57, P = 0.006). In addition, mean SBP decreased by 4 mmHg and 15 mmHg from baseline to 12 months in the PVI alone and PVI plus RDN groups, respectively (P < 0.001).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [163] Steinberg, J. S. et al. Effect of renal denervation and catheter ablation vs catheter ablation alone on atrial fibrillation recurrence among patients with paroxysmal atrial fibrillation and hypertension: the ERADICATE-AF randomized clinical trial. JAMA 323, 248–255 (2020). source

  • May combine two claims.

    Study design and conductcitation

    Large clinical trials of renal denervation have excluded patients with glomerular filtration rate below 45 ml/min/1.73 m2, making the efficacy of this approach in patients with kidney failure difficult to discern.

    “As large clinical trials of RDN have excluded patients with GFR <45 ml/min/1.73 m2 (ref. 119), the efficacy of this approach in patients with kidney failure is difficult to discern.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [119] Schmieder, R. E. Renal denervation in patients with chronic kidney disease: current evidence and future perspectives. Nephrol. Dial. Transpl. 38, 1089–1096 (2023). source

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    Preclinical studies in sheep and rat models show that renal denervation improves renal function and reduces blood pressure in chronic kidney disease, with effects beyond blood pressure reduction.

    “However, the beneficial effects of RDN on CKD are not limited to its antihypertensive effects, with studies showing direct improvement in renal function following ablation of the renal nerves.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [71] Singh, R. R. et al. Sustained decrease in blood pressure and reduced anatomical and functional reinnervation of renal nerves in hypertensive sheep 30 months after catheter-based renal denervation. Hypertension 73, 718–727 (2019). source
    • cites [110] Singh, R. R. et al. Increase in bioavailability of nitric oxide after renal denervation improves kidney function in sheep with hypertensive kidney disease. Hypertension 77, 1299–1310 (2021). source

      The Basal Cardiovascular and Renal Function results report lower blood pressure and, at 30 months, higher renal blood flow and glomerular filtration rate after denervation in sheep with CKD. The Discussion links improved renal hemodynamics to nitric oxide, supporting a renal effect beyond simply reporting blood-pressure reduction. This paper does not report a rat experiment showing improved renal function, nor does it establish that the kidney-function improvement is independent of blood-pressure lowering. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [111] Singh, R. R. et al. Catheter-based renal denervation exacerbates blood pressure fall during hemorrhage. J. Am. Coll. Cardiol. 69, 951–964 (2017). source

      The Renal Function results (page not supplied) report that denervation lowered blood pressure and increased GFR and renal blood flow at five months in sheep with hypertensive CKD. The paper does not establish that the renal improvement was independent of blood-pressure reduction, and it does not report a comparable CKD finding in rats. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a rat model of chronic heart failure, afferent renal denervation caused significant reductions in serum noradrenaline levels and normalized lumbar sympathetic nerve activity.

    “Notably, in a rat model of chronic heart failure, ARDN caused significant reductions in serum noradrenaline levels and normalized lumbar sympathetic nerve activity6.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Zheng, H., Katsurada, K., Liu, X., Knuepfer, M. M. & Patel, K. P. Specific afferent renal denervation prevents reduction in neuronal nitric oxide synthase within the paraventricular nucleus in rats with chronic heart failure. Hypertension 72, 667–675 (2018). source

  • May combine two claims.

    Premisecitation

    A meta-analysis of the ERADICATE-AF trial and five smaller studies found that renal denervation plus pulmonary vein isolation reduced atrial fibrillation recurrence (risk ratio 0.62, 95% CI 0.52-0.75) and decreased systolic and diastolic blood pressure compared with pulmonary vein isolation alone.

    “A meta-analysis of data from the ERADICATE-AF trial and five smaller studies of RDN in patients with hypertension and atrial fibrillation who were undergoing PVI reported a risk ratio for recurrence of atrial fibrillation among those in the PVI plus RDN group versus the PVI alone group of 0.62 (95% CI 0.52–0.75)141. A pooled analysis of the blood pressure data collected in these trials showed”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [141] Nawar, K., Mohammad, A., Johns, E. J. & Abdulla, M. H. Renal denervation for atrial fibrillation: a comprehensive updated systematic review and meta-analysis. J. Hum. Hypertens. 36, 887–897 (2022). source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Increased sympathetic activity is a compensatory response to heart failure that acts to maintain blood pressure and organ perfusion in the setting of reduced cardiac output, but becomes detrimental over time.

    “Increased sympathetic activity is a compensatory response to heart failure that acts to maintain blood pressure and organ perfusion in the setting of reduced cardiac output. Although initially beneficial, this increased activity becomes detrimental over time, causing cardiac hypertrophy, arrhythmias and fibrosis124.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [124] Borovac, J. A., D’Amario, D., Bozic, J. & Glavas, D. Sympathetic nervous system activation and heart failure: current state of evidence and the pathophysiology in the light of novel biomarkers. World J. Cardiol. 12, 373–408 (2020). source

  • May combine two claims.

    Study design and conductcitation

    The first clinical trial of renal denervation in patients with heart failure with preserved ejection fraction was terminated early because of recruitment difficulties and was underpowered to determine whether the procedure had beneficial effects on heart failure symptoms, but it reported that the technique was safe in this patient population.

    “The first clinical trial of RDN in patients with HFpEF was terminated early because of recruitment difficulties and so was underpowered to determine whether the procedure had beneficial effects on heart failure symptoms153. However, this study reported that the technique was safe in this patient population.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [153] Patel, H. C. et al. Renal denervation in heart failure with preserved ejection fraction (RDT-PEF): a randomized controlled trial. Eur. J. Heart Fail. 18, 703–712 (2016). source

  • May combine two claims.

    Premisecitation

    In a randomized clinical trial of patients with chronic kidney disease stage 4, renal denervation significantly reduced the frequency of anti-tachycardia therapy pacing and the number of implantable cardioverter-defibrillator-delivered shocks compared with control.

    “among participants with CKD stage 4, those in the RDN group showed significant decreases in the frequency of anti-tachycardia therapy pacing (ATP) during 18 months of follow-up compared with those in the control group (10 ± 3.2 events versus 48.8 ± 4.6 events). Over the same time period, the number of implantable cardioverter–defibrillator-delivered shocks was far lower in the RDN group than in”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [166] Kiuchi, M. G., Chen, S., Paz, L. M. R. & Purerfellner, H. Renal sympathetic denervation guided by renal nerve stimulation to treat ventricular arrhythmia in CKD patients with ICD. Oncotarget 8, 37296–37307 (2017). source

  • May combine two claims.

    Premisecitation

    Small studies and case reports show that renal denervation reduces blood pressure and is safe in patients with kidney failure on haemodialysis.

    “a small clinical trial in 24 patients with kidney failure on haemodialysis confirmed the safety of the procedure in these patients and demonstrated that RDN resulted in significant reductions in DBP and SBP that persisted for at least 12 months64.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [64] Scalise, F. et al. Renal denervation in patients with end-stage renal disease and resistant hypertension on long-term haemodialysis. J. Hypertens. 38, 936–942 (2020). source
    • cites [120] Di Daniele, N., De Francesco, M., Violo, L., Spinelli, A. & Simonetti, G. Renal sympathetic nerve ablation for the treatment of difficult-to-control or refractory hypertension in a haemodialysis patient. Nephrol. Dial. Transpl. 27, 1689–1690 (2012). source

      The Abstract reports lower systolic and diastolic blood pressure one month after renal denervation in a single haemodialysis patient. It describes a case report, not a 24-patient clinical trial, and does not establish procedural safety or blood-pressure reductions lasting at least 12 months. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [121] Hering, D. et al. Renal denervation in moderate to severe CKD. J. Am. Soc. Nephrol. 23, 1250–1257 (2012). source

      The Abstract reports lower systolic and diastolic blood pressure through 12 months and suggests a favorable short-term safety profile. But the study treated 15 patients with stage 3–4 CKD and resistant hypertension, not 24 patients with kidney failure on haemodialysis; it does not establish safety in that population. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisenone given

    Selective afferent renal denervation improved kidney function in a chronic kidney disease model.

    “Selective afferent RDN also improved kidney function in a chronic kidney disease model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Sympathetic activation lowers GFR and renal blood flow by constricting the afferent arteriole, raises renin release from juxtaglomerular cells, and increases tubular sodium and water reabsorption.

    “Sympathetic nerve activation decreases the glomerular filtration rate (GFR) and renal blood flow through constriction of the afferent arteriole, increases renin release from juxtaglomerular cells and promotes tubular sodium and water reabsorption.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Noradrenaline acting at α1-AR prevents sodium-induced decreases in NCC expression in the distal convoluted tubule, an effect linked to salt-sensitive hypertension.

    “Noradrenaline acting at α1-AR prevents sodium-induced reductions in Na–Cl cotransporter (NCC, also known as SLC12A3) expression in the distal convoluted tubule, an effect that is associated with the development of salt-sensitive hypertension28.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Frame, A. A. et al. Sympathetic regulation of NCC in norepinephrine-evoked salt-sensitive hypertension in Sprague-Dawley rats. Am. J. Physiol. Renal Physiol. 317, F1623–F1636 (2019). source

  • Classified as probably not a substantial claim.

    Premisenone given

    Higher renal sympathetic nerve activity is proposed to contribute to hypertension by increasing renal sodium retention, renin release and renal vasoconstriction.

    “Increased renal sympathetic nerve activity is thought to contribute to hypertension by promoting renal sodium retention, renin release and renal vasoconstriction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Renal denervation lowers Na+-K+-ATPase activity in the proximal tubule, probably reducing active transport generally in that nephron region.

    “RDN reduces the activity of Na+-K+-ATPase in the proximal tubule, likely resulting in generalized reductions in active transport in this region of the nephron3.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Johns, E. J., Kopp, U. C. & DiBona, G. F. Neural control of renal function. Compr. Physiol. 1, 731–767 (2011). source

  • May combine two claims.

    Interpretationreasoning

    These renal actions are expected to raise blood pressure, which suggests that sympathetic drive to the kidney contributes to hypertension.

    “Together, these actions are expected to increase blood pressure, suggesting a role of sympathetic drive to the kidney in the development of hypertension.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Selective afferent renal denervation has not been performed in clinical studies, so its effects have been assessed only in rodents.

    “To date, ARDN has not been performed in clinical studies, so assessment of its effects has been limited to rodent models.”
    • Also stated in: § Afferent renal nerves regulate sympathetic activity · plain
      “Selective ARDN has not yet been performed in humans.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Afferent sensory renal nerves detect chemical and physical changes inside the kidney and project to the nucleus tractus solitarius.

    “Afferent sensory renal nerves respond to chemical and physical changes in the intra-renal environment and project to the nucleus tractus solitarius in the brainstem1,3.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Osborn, J. W. & Foss, J. D. Renal nerves and long-term control of arterial pressure. Compr. Physiol. 7, 263–320 (2017). source
    • cites [3] Johns, E. J., Kopp, U. C. & DiBona, G. F. Neural control of renal function. Compr. Physiol. 1, 731–767 (2011). source

  • May combine two claims.

    Premisecitation

    The kidney receives sympathetic efferent renal nerves and sensory afferent renal nerves.

    “The kidney is innervated by sympathetic efferent renal nerves that relay information from the brain to the kidney and sensory afferent renal nerves that relay information from the kidney to the brain1–3.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Osborn, J. W. & Foss, J. D. Renal nerves and long-term control of arterial pressure. Compr. Physiol. 7, 263–320 (2017). source
    • cites [2] Osborn, J. W., Tyshynsky, R. & Vulchanova, L. Function of renal nerves in kidney physiology and pathophysiology. Annu. Rev. Physiol. 83, 429–450 (2021). source
    • cites [3] Johns, E. J., Kopp, U. C. & DiBona, G. F. Neural control of renal function. Compr. Physiol. 1, 731–767 (2011). source

  • May combine two claims.

    Premisecitation

    In 2K1C hypertensive mice, stimulating afferent renal nerves increased splanchnic, renal and lumbar sympathetic nerve activity, and afferent renal denervation lowered sympathetic activity.

    “Stimulation of afferent renal nerves increased splanchnic, renal and lumbar sympathetic nerve activity in two-kidney, one-clip (2K1C) hypertensive mice and ARDN lowered sympathetic activity in this model5.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Ong, J. et al. Renal sensory nerves increase sympathetic nerve activity and blood pressure in 2-kidney 1-clip hypertensive mice. J. Neurophysiol. 122, 358–367 (2019). source

  • May combine two claims.

    Premisecitation

    Most afferent renal nerves (75-80%) are slow-conducting unmyelinated C-fibres, about 20% are thinly myelinated A-δ fibres, and about 5% are rapidly conducting myelinated fibres.

    “The majority (75–80%) of afferent renal nerves are slow conducting, unmyelinated C-fibres, ~20% are faster conducting, thinly myelinated A-δ fibres and a very small proportion42–44 (~5%) are rapidly conducting myelinated fibres44.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [42] Niijima, A. Observation on the localization of mechanoreceptors in the kidney and afferent nerve fibres in the renal nerves in the rabbit. J. Physiol. 245, 81–90 (1975). source
    • cites [43] Knuepfer, M. M., Akeyson, E. W. & Schramm, L. P. Spinal projections of renal afferent nerves in the rat. Brain Res. 446, 17–25 (1988). source
    • cites [44] Knuepfer, M. M. & Schramm, L. P. The conduction velocities and spinal projections of single renal afferent fibers in the rat. Brain Res. 435, 167–173 (1987). source

  • May combine two claims.

    Interpretationcitation

    Although denervation of the clipped kidney was not afferent-specific, the effect was probably caused by ablating afferent renal nerves.

    “Although RDN of the clipped kidney was not afferent specific, this response was likely the result of ablation of afferent renal nerves.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    These categories may overlap, because intrapelvic substance P and mechanical stretch activate the same afferent renal nerve unit.

    “Notably, these categories might not be entirely distinct, as both intrapelvic administration of substance P and mechanical stretch have been shown to activate the same afferent renal nerve unit45.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Ma, M. C., Huang, H. S., Wu, M. S., Chien, C. T. & Chen, C. F. Impaired renal sensory responses after renal ischemia in the rat. J. Am. Soc. Nephrol. 13, 1872–1883 (2002). source

  • May combine two claims.

    Premisecitation

    Noradrenaline increases amiloride-sensitive currents in cortical collecting duct cells, suggesting greater ENaC activity.

    “noradrenaline increases amiloride-sensitive currents in cortical collecting duct cells, which is suggestive of an increase in ENaC activity30.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Mansley, M. K., Neuhuber, W., Korbmacher, C. & Bertog, M. Norepinephrine stimulates the epithelial Na+ channel in cortical collecting duct cells via α2-adrenoceptors. Am. J. Physiol. Renal Physiol. 308, F450–F458 (2015). source

  • May combine two claims.

    Premisecitation

    About 60% of patients with autosomal-dominant polycystic kidney disease have kidney pain, thought to come from cyst-induced distension of the kidney capsule.

    “~60% of patients with autosomal-dominant polycystic kidney disease experience kidney pain56, which is thought to result from renal cyst-induced distension of the kidney capsule57.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [56] Gabow, P. A. Autosomal dominant polycystic kidney disease–more than a renal disease. Am. J. Kidney Dis. 16, 403–413 (1990). source
    • cites [57] Lugo-Gavidia, L. M. et al. Interventional approaches for loin pain hematuria syndrome and kidney-related pain syndromes. Curr. Hypertens. Rep. 22, 103 (2020). source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Juxtaglomerular cells make, store and release renin, which cleaves angiotensinogen into angiotensin I.

    “Juxtaglomerular cells produce, store and release renin, which cleaves angiotensinogen to form angiotensin I.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The signal transduced by afferent renal nerves in hypertension is produced by the kidney and is unlikely to be a circulating factor.

    “This finding strongly suggests that the signal that is transduced by afferent renal nerves in hypertension is produced by the kidney and is unlikely to be a circulating factor.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the DOCA-salt mouse, IL-1β antagonism has the same anti-hypertensive efficacy as afferent renal denervation, and combining the two treatments gives no extra blood pressure reduction.

    “The anti-hypertensive efficacy of IL-1β antagonism is identical to that of ARDN in the DOCA-salt mouse, and no additional reduction in blood pressure has been observed when these treatments are combined84.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] Baumann, D., Van Helden, D., Evans, L. & Osborn, J. IL-1R mediated renal sensory nerve activity drives hypertension in the DOCA-Salt mouse. Physiology 38, 1811–1821 (2023). source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Medication compliance is thought to be particularly low in patients with resistant hypertension (23-66%).

    “Medication compliance is thought to be particularly low in this patient population (23–66%)67.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Berra, E. et al. Evaluation of adherence should become an integral part of assessment of patients with apparently treatment-resistant hypertension. Hypertension 68, 297–306 (2016). source

  • May combine two claims.

    Premisecitation

    Clinical and preclinical studies show that renal nerve ablation lowers blood pressure, and renal denervation has been approved by the FDA for resistant hypertension.

    “Clinical and preclinical studies have shown that ablation of renal nerves reduces blood pressure and RDN has been approved by the FDA for the treatment of resistant hypertension13,14.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] FDA. Premarket Approval (PMA) Symplicity Spyral® Renal Denervation System. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P220026 (2023).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [14] FDA. Premarket Approval (PMA) Paradise® Ultrasound Renal Denervation System. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P220023 (2023).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Activation of sympathetic renal nerves causes afferent arteriolar constriction, increased sodium retention and increased renin secretion from juxtaglomerular cells, all of which raise blood pressure.

    “activation of the sympathetic renal nerves causes afferent arteriolar constriction, increased sodium retention and increased renin secretion from juxtaglomerular cells1, all of which increase blood pressure.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Osborn, J. W. & Foss, J. D. Renal nerves and long-term control of arterial pressure. Compr. Physiol. 7, 263–320 (2017). source

  • May combine two claims.

    Premisecitation

    The blood pressure reduction after renal denervation occurred regardless of the device used and in patients both receiving and not receiving antihypertensive medications.

    “This response occurred independently of the device used and in patients who were and in those who were not receiving anti-hypertensive medications92.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Ogoyama, Y. et al. Effects of renal denervation on blood pressures in patients with hypertension: a systematic review and meta-analysis of randomized sham-controlled trials. Hypertens. Res. 45, 210–220 (2022). source

  • May combine two claims.

    Interpretationreasoning

    The blood pressure effects of renal denervation do not depend on kidney function, because the trial participants had minimal kidney function.

    “This finding suggests that the blood pressure effects of RDN are not dependent on kidney function, which was minimal in the participants.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Renal denervation can prevent hypertension from developing and can also blunt its progression.

    “Notably, RDN can not only prevent the development of hypertension but also blunt its progression, demonstrating the therapeutic potential of the technique.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These conditions are all associated with increased sympathetic drive, suggesting that afferent renal denervation might have similar efficacy to total renal denervation.

    “Notably, these conditions are all associated with increased sympathetic drive, suggesting that ARDN, which is associated with reductions in sympathetic activity5,21, might have similar efficacy to TRDN.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Ong, J. et al. Renal sensory nerves increase sympathetic nerve activity and blood pressure in 2-kidney 1-clip hypertensive mice. J. Neurophysiol. 122, 358–367 (2019). source
    • cites [21] Veiga, A. C. et al. Selective afferent renal denervation mitigates renal and splanchnic sympathetic nerve overactivity and renal function in chronic kidney disease-induced hypertension. J. Hypertens. 38, 765–773 (2020). source

  • May combine two claims.

    Premisecitation

    Renal denervation was associated with stabilization of estimated glomerular filtration rate for up to 24 months after the procedure, an effect not dependent on reductions in blood pressure.

    “RDN was associated with stabilization of eGFR for up to 24 months after the procedure, an effect that was not dependent on reductions in blood pressure115.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [115] Hering, D. et al. Effect of renal denervation on kidney function in patients with chronic kidney disease. Int. J. Cardiol. 232, 93–97 (2017). source

  • May combine two claims.

    Interpretationreasoning

    The findings highlight the emerging role of the kidney as an interoceptive organ and suggest that the beneficial effects of renal denervation may extend beyond conditions traditionally thought to be renal in origin to those associated with increased sympathetic nerve activity.

    “These findings highlight the emerging role of the kidney as an interoceptive organ and suggest that the beneficial effects of RDN may extend beyond conditions that are traditionally thought to be renal in origin to those that are associated with increased sympathetic nerve activity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Renal denervation may help to preserve renal function and slow disease progression in patients with mild to moderate chronic kidney disease.

    “Together these data suggest that RDN may help to preserve renal function and slow disease progression in patients with mild to moderate CKD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Chronic kidney disease is a cause and a consequence of hypertension.

  • May combine two claims.

    Interpretationcitation

    Clinical studies of renal denervation in patients with heart failure are limited, but initial results are promising.

    “Clinical studies of RDN in patients with heart failure are limited, but initial results are promising (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The results of small clinical studies and retrospective analyses suggest that renal denervation may be an effective therapeutic approach in patients with heart failure with preserved ejection fraction and support the need for larger clinical trials in this population.

    “The results of small clinical studies and retrospective analysis suggest that RDN may be an effective therapeutic approach in patients with HFpEF and support the need for larger clinical trials in this population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Promising preclinical and clinical data suggest that renal denervation might be beneficial for the treatment of chronic kidney disease, heart failure and arrhythmias.

    “Promising preclinical and clinical data suggest that RDN might be beneficial for the treatment of CKD, heart failure and arrhythmias.”
    Quote in the paperSubstantial claim
54 of 54

  • The paper relies on this without support.

    Chronic kidney disease is a cause and a consequence of hypertension.

    “As CKD is a cause and a consequence of hypertension, it is intuitive that RDN, which lowers blood pressure, will also slow the progression of CKD.”

  • The paper relies on this without support.

    Patients with chronic kidney disease and hypertension have a high prevalence of arrhythmias.

    “Patients with CKD and hypertension have a high prevalence of arrhythmias.”

  • The paper relies on this without support.

    Blood pressure control has not been demonstrated to reduce episodes of atrial fibrillation in previously diagnosed patients.

    “Although hypertension is a risk factor for the incidence of atrial fibrillation, blood pressure control has not been demonstrated to reduce episodes of atrial fibrillation in previously diagnosed patients.”
3 of 3

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Authors
Evans, L. C., Dayton, A., & Osborn, J. W.
Affiliations
University of Minnesota (US)
Corresponding author
Osborn, John W.
ORCID
Venue
Nature Reviews Nephrology
Publisher
Springer Science and Business Media LLC
Published
2024-10-03
Volume
21
Issue
1
Pages
57-69
ISSN
  • 1745-8323 (ISSN-L)
  • 1759-5061
  • 1759-507X
DOI
10.1038/s41581-024-00893-3
PMC
PMC13539610
OpenAlex
W4403100601
Cited by
46
References
177
Citations by year
2026: 32 · 2025: 14
FWCI
3.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature Reviews Nephrology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
  • National Heart, Lung, and Blood Institute (R01HL152166, T32HL144472)
  • National Center for Complementary and Integrative Health (U54AT012307)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
renal nerves, renal denervation, renal afferent nerves, hypertension, chronic kidney disease, heart failure, cardiac arrhythmias, interoception, sympathetic nervous system, renal sodium retention, renin secretion, renal vasoconstriction, cardiorenal disease
MeSH terms
Animals, Humans, Hypertension, Kidney, Sympathectomy, Sympathetic Nervous System, Catheter Ablation, Renal Insufficiency, Chronic, Interoception

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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