May 18, 2012Journal of the American Society of Nephrology359 citationsOpen Access
Renal Denervation in Moderate to Severe CKD
Key Result
Catheter-based bilateral renal denervation significantly reduced office systolic blood pressure by 32 mmHg at 6 months without deteriorating renal function in patients with resistant hypertension and stage 3-4 CKD.
Study Design
Type
Cohort (n=15)
Multicenter
Yes
Structured PICO
Does bilateral renal denervation reduce blood pressure safely in patients with resistant hypertension and stage 3-4 CKD?
P
Population
15 patients with resistant hypertension and stage 3-4 CKD (mean eGFR, 31 ml/min per 1.73 m(2))
I
Intervention
Bilateral renal denervation (catheter-based renal nerve ablation)
O
Outcome
Change in estimated GFR and office systolic and diastolic BP at 1, 3, 6, and 12 monthssurrogate
Bilateral renal denervation appears safe and significantly reduces blood pressure in patients with resistant hypertension and stage 3-4 CKD over 12 months.
Main Result
p-value: p=<0.001
Limitations
- Small sample size
- Lack of a control group
- Limited number of patients with valid ambulatory BP monitoring data
- Only five patients completed the 12-month follow-up
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.