Predisposing factors to heart failure in diabetic nephropathy: a look at the sympathetic nervous system hyperactivity

Klara Komici, Grazia Daniela Femminella, Claudio de Lucia, Alessandro Cannavo, Leonardo Bencivenga, Graziamaria Corbi, Dario Leosco, Nicola Ferrara, Giuseppe Rengo

Research output: Contribution to journalReview articlepeer-review


Diabetes mellitus (DM) and heart failure (HF) are frequent comorbidities among elderly patients. HF, a leading cause of mortality and morbidity worldwide, is characterized by sympathetic nervous system hyperactivity. The prevalence of diabetes mellitus (DM) is rapidly growing and the risk of developing HF is higher among DM patients. DM is responsible for several macro- and micro-angiopathies that contribute to the development of coronary artery disease (CAD), peripheral artery disease, retinopathy, neuropathy and diabetic nephropathy (DN) as well. Independently of CAD, chronic kidney disease (CKD) and DM increase the risk of HF. Individuals with diabetic nephropathy are likely to present a distinct pathological condition, defined as diabetic cardiomyopathy, even in the absence of hypertension or CAD, whose pathogenesis is only partially known. However, several hypotheses have been proposed to explain the mechanism of diabetic cardiomyopathy: increased oxidative stress, altered substrate metabolism, mitochondrial dysfunction, activation of renin-angiotensin-aldosterone system (RAAS), insulin resistance, and autonomic dysfunction. In this review, we will focus on the involvement of sympathetic system hyperactivity in the diabetic nephropathy.

Original languageEnglish
Pages (from-to)321-330
Number of pages10
JournalAging Clin. Exp. Res.
Issue number3
Publication statusPublished - Mar 2019


  • Diabetic Cardiomyopathies/etiology
  • Diabetic Nephropathies/complications
  • Heart Failure/etiology
  • Humans
  • Sympathetic Nervous System/physiopathology


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