Renal denervation in hypertensive patients with renal impairment: ultra-long-term follow-up study

Abstract Background Renal denervation (RDN) has emerged as a promising therapeutic adjunct for the management of hypertension, yet its efficacy in the long term, particularly in patients with hypertension and concurrent renal insufficiency, remains to be fully elucidated. This study was designed to evaluate the sustained impact of RDN on blood pressure control, renal function, and cardiovascular outcomes in hypertensive patients with pre-existing renal impairment over an extended follow-up period. Methods We conducted a single-center, single-arm, real-world retrospective study involving patients with hypertension and chronic kidney disease (CKD) stages 3-4 who underwent RDN at a hospital between 2011 and 2016. Comprehensive baseline data, including demographic information, comorbidities, and medication history, were meticulously recorded. Long-term follow-up assessments were performed at 1, 5, and 11.5 years post-RDN to monitor changes in office and home blood pressure, 24-hour ambulatory blood pressure results, renal function, and the incidence of cardiovascular events and mortality. Results A total of 20 participants completed the long-term follow-up, with a mean age of 51.7 ± 14.5 years (35% female), and a median follow-up duration of 11.5 years. At baseline, the cohort presented with an average office systolic blood pressure of 183.8 ± 18.6 mmHg and a diastolic blood pressure of 104.7 ± 17.0 mmHg. Following RDN, participants experienced a significant reduction in blood pressure, with an average decrease of -37.94/-20.38 mmHg (P 0.001) compared to baseline. Additionally, ambulatory systolic and diastolic blood pressures were reduced by 16.87 ± 9 mmHg (P 0.001) and 9.88 ± 4.05 mmHg (P 0.001) 11.5 years after the procedure, respectively. The study also revealed a substantial reduction in the need for antihypertensive medications (P 0.001) and a decrease in average heart rate (P = 0.046) following renal denervation. Assessments of renal function, as measured by estimated glomerular filtration rate and creatinine levels, were consistent with expected age-related decline. Importantly, no significant adverse events associated with RDN were observed in the long-term follow-up. Over the 11.5-year period, the cardiovascular mortality rate and overall mortality were 10% and 20%, respectively. Conclusion This long-term follow-up study demonstrates that RDN is a safe and effective intervention for managing hypertension in patients with renal impairment.