Renal denervation in moderate to severe CKD

Abstract

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 ± SD was 174 ± 22/91 ± 16 mmHg despite the use of 5.6 ± 1.3 antihypertensive drugs. Mean changes in office systolic and diastolic BP at 1, 3, 6, and 12 months were -34/-14, -25/-11, -32/-15, and -33/-19 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.

Figure 1.

Individual changes in creatinine-based estimated GFR before renal denervation (pre-RDN); at 1 week (W); and at 1-, 3-, 6-, and 12-month (M) follow-up (FU).

Figure 2.

Office BP values at follow-up. Changes in average office BP (A) and mean decrease in office BP (B) at follow-up. Error bars represent SDs. *P<0.001 versus baseline (before the procedure). FU, follow-up; M, month; pre-RDN, prerenal denervation.

Figure 3.

Peripheral augmentation index before and after 3-month follow-up. Error bars represent SDs. AI, augmentation index; FU, follow-up; M, month; pre-RDN, prerenal denervation.