Renal Sympathetic Denervation in Mild to Moderate Chronic Kidney Disease Patients with Chronic Heart Failure Refractory to Cardiac Resynchronization Therapy: A Safety Evaluation Study

Background: Heart failure (HF) is a challenging disease to control. Chronic overactivation of the sympathetic nervous system occurs early in HF and chronic kidney disease (CKD). The aim of this study was to evaluate the safety and effects of renal sympathetic denervation (RSD) in reducing lesions on the heart and kidneys in patients with CKD and HF refractory to cardiac resynchronization therapy (CRT). Methods and results: Twenty-one patients were included and treated with a standard irrigated cardiac ablation catheter. RSD was performed by a unique operator. All the patients included in the study had HF in functional New York Health Association (NYHA) class III, were refractory to CRT, and had mild-to-moderate CKD. Data were obtained at baseline, and at 6 and 12 months of follow-up. RSD was safe and feasible to perform in this population. No changes in blood pressure were observed during this period. At baseline, patients walked 172.4 ± 26.4 m during a 6-minute walk test, increasing to 209.4 ± 29.1 m at 12 months post RSD (p<0.001). All echocardiographic parameters evaluated improved at 6 (p<0.001) and 12 months (p<0.001) after RSD. Estimated glomerular filtration rate improved from 67.4 ± 20.5 mL/min/1.73 m2 at baseline to 87.8 ± 17.9 mL/min/1.73 m2 at 12 months post procedure (p<0.001). At 12 months after RSD, 42% of patients were in functional NYHA class I, 50% were in functional class II, and 8% remained in functional NYHA class III. Conclusions: RSD seemed to be safe, feasible, and effective, resulting in an improvement in echocardiographic parameters, 6-minute walk test distance, renal function, and functional NYHA class in mild-to-moderate CKD patients with HF refractory to CRT.