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. 2022 Dec 14:9:1010546.
doi: 10.3389/fcvm.2022.1010546. eCollection 2022.

Favorable effect of renal denervation on elevated renal vascular resistance in patients with resistant hypertension and type 2 diabetes mellitus

Musheg Manukyan  1 , Alla Falkovskaya  1 , Victor Mordovin  1 , Stanislav Pekarskiy  1 , Irina Zyubanova  1 , Ekaterina Solonskaya  1 , Tamara Ryabova  1 , Simzhit Khunkhinova  1 , Anastasia Vtorushina  1 , Sergey Popov  1
Affiliations

Favorable effect of renal denervation on elevated renal vascular resistance in patients with resistant hypertension and type 2 diabetes mellitus

Musheg Manukyan et al. Front Cardiovasc Med. .

Abstract

Objective: To assess the effect of renal denervation (RDN) on renal vascular resistance and renal function in patients with drug-resistant hypertension (HTN) and type 2 diabetes mellitus (T2DM).

Materials and methods: Fifty-nine patients (mean age 60.3 ± 7.9 years, 25 men) with resistant HTN [mean 24-h ambulatory blood pressure (BP) 158.0 ± 16.3/82.5 ± 12.7 mmHg, systolic/diastolic] and T2DM (mean HbA1c 7.5 ± 1.5%) were included in the single-arm prospective study and underwent RDN. Renal resistive index (RRI) derived from ultrasound Doppler; estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula), office and 24-h ambulatory BP were measured at baseline, 6, and 12 months after RDN to evaluate the respective changes in renal vascular resistance, renal function, and BP during treatment.

Results: Forty-three patients completed 12 months follow-up. The RRI changed depending on the baseline value. Specifically, the RRI decreased significantly in patients with elevated baseline RRI values ≥ 0.7 {n = 23; -0.024 [95% confidence interval (CI): -0.046, -0.002], p = 0.035} and did not change in those with baseline RRI < 0.7 [n = 36; 0.024 (95% CI: -0.002, 0.050), p = 0.069]. No significant change was observed in eGFR whereas BP was significantly reduced at 12 months after RDN by -10.9 (95% CI: -16.7, -5.0)/-5.5 (95% CI: -8.7, -2.4) mmHg, systolic/diastolic. No relationship was found between the changes in RRI and BP.

Conclusion: Our study shows that RDN can decrease elevated renal vascular resistance (RRI > 0.7) and stabilize kidney function in patients with RHTN and T2DM independently of its BP-lowering effect.

Keywords: renal denervation; renal function; renal hemodynamics; renal resistive index; resistant hypertension; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study flow chart. From the total number of patients (n = 67), 59 patients underwent renal denervation (RDN), after the exclusion of eight patients due to renal artery stenosis.
FIGURE 2
FIGURE 2
Frequency of renal resistive index (RRI) decrease by ≥ 0.05 at 6 and 12 months after renal denervation (RDN). Data are presented as number (%).
FIGURE 3
FIGURE 3
Changes in estimated glomerular filtration rate (eGFR) during the year after renal denervation (RDN) in groups of patients with high and normal renal resistive index (RRI).
FIGURE 4
FIGURE 4
Comparison of changes in 24-h ambulatory blood pressure (BP) values at 6 and 12 months after renal denervation (RDN). Data are mean and 95% confidence interval.
See this image and copyright information in PMC

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