Long-Term Effects of Renal Sympathetic Denervation on Hypertensive Patients With Mild to Moderate Chronic Kidney Disease

Abstract

Thirty patients who underwent percutaneous renal denervation, which was performed by a single operator following the standard technique, were enrolled in this study. Patients with chronic kidney disease (CKD) stage 2 (n=19), 3 (n=6), and 4 (n=5) were included. Data were obtained at baseline and at monthly intervals for the first 6 months. At 7 months, follow-up data were collected bimonthly until month 12, after which data were collected on a quarterly basis. Baseline blood pressure values (mean±standard deviation) were 185±18/107±13 mm Hg in the office and 152±17/93±11 mm Hg through 24-hour ambulatory blood pressure monitoring (ABPM). Three patients with stage 4 CKD required chronic renal replacement therapy (one at the 13-month follow-up and two at the 14-month follow-up) after episodes of acute renal injury; their follow-up was subsequently discontinued. The office blood pressure values at the 24-month follow-up were 131±15/87±9 mm Hg (P<.0001, for both comparisons); the corresponding ABPM values were 132±14/84±12 mm Hg (P<.0001, for both comparisons). The mean estimated glomerular filtration rate increased from 61.9±23.9 mL/min/1.73 m(2) to 88.0±39.8 mL/min/1.73 m(2) (P<.0001). The urine albumin:creatinine ratio decreased from 99.8 mg/g (interquartile range, 38.0-192.1) to 11.0 mg/g (interquartile range, 4.1-28.1; P<.0001 mg/g). At the end of the follow-up period, 21 patients (70% of the initial sample) were no longer classified as having CKD.

Figure 1

Estimated glomerular filtration rate (eGFR) at baseline and at months 1, 3, 6, 12, 18, and 24 after renal denervation. Values are presented as mean±standard deviation. *P<.0001 vs corresponding baseline values. At months 18 and 24, patients who required chronic renal replacement therapy (n=3) were assigned an eGFR value of 0.

Figure 2

Mean increase (∆) and standard deviation of the estimated glomerular filtration rate (eGFR) at month 24 of the follow‐up period after renal denervation: all patients (circles, n=30), nondiabetic patients (triangles, n=19), and type 2 diabetic patients (squares, n=11). The final values used for the calculation were the ones collected at month 24 for those who completed the study period (n=27). Patients who required chronic renal replacement therapy (n=3) were included with an eGFR value of 0. DM 2 indicates type 2 diabetes mellitus.

Figure 3

Stages of chronic kidney disease (CKD) at baseline and at months 1, 6, 12, and 24 after renal denervation (n=30). CKD stage 5D, chronic kidney disease on dialysis.