Key result
Radiofrequency catheter-based renal denervation significantly blunted total sodium excretion in response to saline loading in hypertensive CKD sheep at 2 months compared to sham (73% vs 130% of infused load, p<0.001).
Why the study?
Renal sympathetic nerves contribute to excretory function during volume expansion, but whether intact renal innervation is required to excrete fluid and electrolyte loads in hypertensive CKD and normotensive states was unknown.
Does radiofrequency catheter-based renal denervation impair fluid and electrolyte excretion during volume expansion in normotensive and hypertensive CKD sheep?
Does radiofrequency catheter-based renal denervation impair fluid and electrolyte excretion during volume expansion in normotensive and hypertensive CKD sheep?
Absolute Event Rate: 73% vs 130%
p-value: p=<0.001
Chronic withdrawal of basal renal sympathetic activity via renal denervation impairs fluid and electrolyte excretion during volume expansion, which may contribute to fluid balance disturbances in hypertensive CKD.
Does not support changes to volume management or denervation in CKD; leaves open whether renal nerves are required for human excretory responses.
Renal sympathetic nerves contribute to renal excretory function during volume expansion. We hypothesized that intact renal innervation is required for excretion of a fluid/electrolyte load in hypertensive chronic kidney disease (CKD) and normotensive healthy settings. Blood pressure, kidney hemodynamic and excretory response to 180 min of isotonic saline loading (0.13 ml/kg/min) were examined in female normotensive (control) and hypertensive CKD sheep at 2 and 11 months after sham (control-intact, CKD-intact) or radiofrequency catheter-based RDN (control-RDN, CKD-RDN) procedure. Basal blood pressure was ~ 7 to 9 mmHg lower at 2, and 11 months in CKD-RDN compared with CKD-intact sheep. Saline loading did not alter glomerular filtration rate in any group. At 2 months, in response to saline loading, total urine and sodium excretion were ~ 40 to 50% less, in control-RDN and CKD-RDN than intact groups. At 11 months, the natriuretic and diuretic response to saline loading were similar between control-intact, control-RDN and CKD-intact groups but sodium excretion was ~ 42% less in CKD-RDN compared with CKD-intact at this time-point. These findings indicate that chronic withdrawal of basal renal sympathetic activity impairs fluid/electrolyte excretion during volume expansion. Clinically, a reduced ability to excrete a saline load following RDN may contribute to disturbances in body fluid balance in hypertensive CKD.
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Singh et al. (2021) studied Hypertensive chronic kidney disease (n=27). Radiofrequency catheter-based renal denervation vs. Sham procedure was evaluated on Total sodium excreted as percent of saline load infused at 2 months (CKD group) (p=<0.001). Radiofrequency catheter-based renal denervation significantly blunted total sodium excretion in response to saline loading in hypertensive CKD sheep at 2 months compared to sham (73% vs 130% of infused load, p<0.001).
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