Key result
Renal denervation significantly reduced systolic office blood pressure by 24.9 mm Hg at 6 months and stabilized kidney function, with no significant decline in eGFR up to 24 months in patients with chronic kidney disease.
Why the study?
The study aimed to evaluate clinical outcomes following renal denervation for hypertensive patients with chronic kidney disease.
Does renal denervation reduce blood pressure and preserve kidney function in patients with treatment-resistant hypertension and chronic kidney disease?
Meta-Analysis (n=226)
Does renal denervation reduce blood pressure and preserve kidney function in patients with treatment-resistant hypertension and chronic kidney disease?
Renal denervation safely and effectively reduces office and ambulatory blood pressure in patients with treatment-resistant hypertension and CKD, while potentially interrupting natural CKD progression.
Answers are grounded in this paper and cite their sources.
Supports renal denervation for resistant hypertension with CKD; extends Level 1 evidence for sustained BP reduction and renal safety.
The present study aims to evaluate the clinical outcomes following renal denervation (RDN) for hypertensive patients with chronic kidney disease (CKD). Prospective studies published between January 1, 2010 and November 15, 2022 where systematically identified for RDN outcomes on office and ambulatory blood pressure, estimated glomerular filtration rate (eGFR), creatinine and procedural characteristics from three online databases (Medline, PubMed, EMBASE). Random effects model to combine risk ratios and mean differences was used. Where possible, clinical outcomes were pooled and analyzed at 6, 12 and 24 months. Significance was set at p ≤ 0.05. 11 prospective trials, with a total of 226 patients with treatment resistant HTN receiving RDN met the inclusion criteria. Age ranged from 42.5 ± 13.8 to 66 ± 9. Main findings of this review included a reduction in systolic and diastolic office blood pressure at 6 [−19.8 ( p < 0.00001)/−15.2 mm Hg ( p < 0.00001)] and 12 months [−21.2 ( p < 0.00001)/−9.86 mm Hg ( p < 0.0005)] follow-up compared to baseline. This was also seen in systolic and diastolic 24-hour ambulatory blood pressure at 6 [−9.77 ( p = 0.05)/−3.64 mm Hg ( p = 0.09)] and 12 months [−13.42 ( p = 0.0007)/−6.30 mm Hg ( p = 0.001)] follow-up compared to baseline. The reduction in systolic and diastolic 24-hour ambulatory blood pressure was maintained to 24 months [(−16.30 ( p = 0.0002)/−6.84 mm Hg ( p = 0.0010)]. Analysis of kidney function through eGFR demonstrated non-significant results at 6 (+1.60 mL/min/1.73 m 2 , p = 0.55), 12 (+5.27 mL/min/1.73 m 2 , p = 0.17), and 24 months (+7.19 mL/min/1.73 m 2 , p = 0.36) suggesting an interruption in natural CKD progression. Similar results were seen in analysis of serum creatinine at 6 (+0.120 mg/dL, p = 0.41), 12 (+0.100 mg/dL, p = 0.70), and 24 months (+0.07 mg/dL, p = 0.88). Assessment of procedural complications deemed RDN in a CKD cohort to be safe with an overall complication rate of 4.86%. With the current advances in RDN and its utility in multiple chronic diseases beyond hypertension, the current study summarizes critical findings that further substantiate the literature regarding the potential of such an intervention to be incorporated as an effective treatment for resistant hypertension and CKD.
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Nawar et al. (2023) conducted a meta-analysis in Chronic kidney disease and treatment-resistant hypertension (n=226). Renal denervation vs. Baseline was evaluated on Change in systolic office blood pressure at 6 months (MD -24.9 mm Hg, p=0.0004). Renal denervation significantly reduced systolic office blood pressure by 24.9 mm Hg at 6 months and stabilized kidney function, with no significant decline in eGFR up to 24 months in patients with chronic kidney disease.
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