Effects of renal denervation on kidney function in patients with chronic kidney disease: a systematic review and meta-analysis

Abstract

The present study aims to evaluate the clinical outcomes following renal denervation (RDN) for hypertensive patients with chronic kidney disease (CKD). Prospective studies published between January 1, 2010 and November 15, 2022 where systematically identified for RDN outcomes on office and ambulatory blood pressure, estimated glomerular filtration rate (eGFR), creatinine and procedural characteristics from three online databases (Medline, PubMed, EMBASE). Random effects model to combine risk ratios and mean differences was used. Where possible, clinical outcomes were pooled and analyzed at 6, 12 and 24 months. Significance was set at p ≤ 0.05. 11 prospective trials, with a total of 226 patients with treatment resistant HTN receiving RDN met the inclusion criteria. Age ranged from 42.5 ± 13.8 to 66 ± 9. Main findings of this review included a reduction in systolic and diastolic office blood pressure at 6 [-19.8 (p < 0.00001)/-15.2 mm Hg (p < 0.00001)] and 12 months [-21.2 (p < 0.00001)/-9.86 mm Hg (p < 0.0005)] follow-up compared to baseline. This was also seen in systolic and diastolic 24-hour ambulatory blood pressure at 6 [-9.77 (p = 0.05)/-3.64 mm Hg (p = 0.09)] and 12 months [-13.42 (p = 0.0007)/-6.30 mm Hg (p = 0.001)] follow-up compared to baseline. The reduction in systolic and diastolic 24-hour ambulatory blood pressure was maintained to 24 months [(-16.30 (p = 0.0002)/-6.84 mm Hg (p = 0.0010)]. Analysis of kidney function through eGFR demonstrated non-significant results at 6 (+1.60 mL/min/1.73 m², p = 0.55), 12 (+5.27 mL/min/1.73 m², p = 0.17), and 24 months (+7.19 mL/min/1.73 m², p = 0.36) suggesting an interruption in natural CKD progression. Similar results were seen in analysis of serum creatinine at 6 (+0.120 mg/dL, p = 0.41), 12 (+0.100 mg/dL, p = 0.70), and 24 months (+0.07 mg/dL, p = 0.88). Assessment of procedural complications deemed RDN in a CKD cohort to be safe with an overall complication rate of 4.86%. With the current advances in RDN and its utility in multiple chronic diseases beyond hypertension, the current study summarizes critical findings that further substantiate the literature regarding the potential of such an intervention to be incorporated as an effective treatment for resistant hypertension and CKD.

Fig. 1. Prisma flow chart of the screening process.

A flow chart illustrating the screening procedure for studies to be included or excluded, along with a breakdown of outcomes at each screening phase.

Fig. 2. Forest plot of the effects of renal denervation on office systolic blood pressure.

A 6 month; B 6 month sensitivity analysis after removal of Kiuchi 2015; C 12 month; D 12 month sensitivity analysis after removal of Kiuchi 2015. IV inverse variance, df degrees of freedom.

Fig. 3. Forest plot of the effects of renal denervation on office diastolic blood pressure.

A 6 month; B 6 month sensitivity analysis after removal of Prasad 2019; C 12 month; D 12 month sensitivity analysis after removal of Kiuchi 2015. IV inverse variance, df degrees of freedom.

Fig. 4. Forest plot of the effects of renal denervation on ambulatory systolic blood pressure.

A 6 month; B 12 month; C 24 month; D 24 month sensitivity analysis after removal of Prasad 2019. IV inverse variance, df degrees of freedom.

Fig. 5. Forest plot of the effects of renal denervation on ambulatory diastolic blood pressure.

A 6 month; B 6 month sensitivity analysis after removal of Scalise 2020; C 12 month; D 24 month; E 24 month sensitivity analysis after removal of Prasad 2019. IV inverse variance, df degrees of freedom.

Fig. 6. Forest plot of the effects of renal denervation on creatinine.

A 6 month; B 12 month; C 12 month sensitivity analysis after removal of Prasad 2019; D 24 month; E 24 month sensitivity analysis after removal of Kiuchi 2015. IV inverse variance, df degrees of freedom.

Fig. 7. Forest plot of the effects of renal denervation on eGFR.

A 6 month; B 12 month; C 12 month sensitivity analysis after removal of Kiuchi 2015; D 24 month; E 24 month sensitivity analysis after removal of Kiuchi 2015. IV inverse variance, df degrees of freedom.