Objective: Increased urinary albumin/creatinine ratio (uACR) is independently associated with renal disease progression, increased cardiovascular morbidity and mortality. UACR reduction improves cardiorenal prognosis. Renal denervation (RDN) may reduce blood pressure (BP) and uACR in patients with hypertensive renal disease.Design and method: Global SYMPLICITY Registry DEFINE (GSR DEFINE) is the largest RDN registry of real-world patients. All underwent radiofrequency (RF) RDN with Flex™, or Spyral™ RDN catheters (Medtronic, Plc). Two groups were analysed: microalbuminuria (uACR 30-299 mg/g), and macroalbuminuria (uACR >=300 mg/g). UACR, estimated glomerular filtration rate (eGFR; CKD-EPI), office systolic BP (OSBP) and antihypertensive medications (AH meds) were assessed at 3, 6, 12, and 24 months follow-up. UACR were log transformed to compare changes from baseline using paired t-tests. Percentage change in geometric mean uACR from baseline to follow-up was calculated. UACR are reported as median (Q1-Q3). Results: 555 patients from GSR had uACR (spot measurements) assessed at baseline. Of these, 125 (23%) had microalbuminuria (median uACR 69 46-128mg/g), mean eGFR 77 mL/min/1.73 m2, and 56 (10%) patients had macroalbuminuria (median uACR 829 437 - 1966mg/g), mean eGFR 56 mL/min/1.73 m2. In microalbuminuria group, mean OSBP was 168±23 mmHg, prescribed 4.8±1.3 AH meds, 42% had diabetes, 45% had history of renal disease. In macroalbuminuria group, mean OSBP was 166±26mmHg, prescribed 5.1±0.9 AH meds, 63% had diabetes, 73% had renal disease history. 24 months after RDN, uACR (geometric mean) was significantly reduced by 50% (95% CI: -68%, -23%) and 66% (95% CI: -82%, -33%) in micro- and macroalbuminuria groups, respectively. Consistent changes were observed at all other timepoints (Figure). Log-transformed uACR showed significant reductions from baseline at all timepoints in both groups (p<0.05). EGFR changes were within the expected age-related range. OSBP reduced by 21.9±26.6mmHg and 16.0±24.4mmHg at 24 months in the micro- and macroalbuminuria groups, respectively. There were no significant changes to AH meds. Conclusions: RDN was associated with significant reductions in albuminuria in a real-world cohort of patients with hypertensive renal disease. Further prospective trials to evaluate the potential nephroprotective effects of RDN are warranted.
Schlaich et al. (Fri,) studied this question.