What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=1980). Intervention: Renal denervation vs. Patients without CKD. Primary outcome: Reduction in office systolic blood pressure at 36 months (p=0.009).

What does this research mean for the field?

Renal denervation effectively reduces blood pressure over 3 years in hypertensive patients, though the reduction in office systolic blood pressure is smaller in patients with chronic kidney disease compared to those without (-11.7 vs -17.3 mmHg). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 8, 2021

Renal denervation in patients with versus without chronic kidney disease: results from the Global SYMPLICITY Registry with follow-up data of 3 years

Key Result

Renal denervation reduced office systolic blood pressure at 36 months, with a smaller reduction in hypertensive patients with CKD versus those without (-11.7 vs -17.3 mmHg; P=0.009).

Study Design

Type

Observational (n=1,980)

Multicenter

Yes

Structured PICO

Does renal denervation reduce blood pressure effectively and safely in hypertensive patients with chronic kidney disease compared to those without?

Population

1,980 hypertensive patients from the Global SYMPLICITY Registry, stratified by the presence (n=475, eGFR <60 mL/min/1.73 m2) or absence (n=1505, eGFR ≥60 mL/min/1.73 m2) of chronic kidney disease.

Intervention

Renal denervation (RDN)

Comparator

Hypertensive patients without chronic kidney disease (eGFR ≥60 mL/min/1.73 m2) undergoing RDN

Outcome

Change in office and 24-h ambulatory blood pressure at 36 monthssurrogate

Renal denervation is an effective and safe antihypertensive treatment option for patients with chronic kidney disease, yielding similar 24-hour ambulatory blood pressure reductions to patients without CKD at 3 years.

Main Result

Absolute Event Rate: -11.7% vs -17.3%

p-value: p=0.009

Abstract

Abstract Background Activity of the sympathetic nervous system is increased in patients with hypertension and chronic kidney disease (CKD). Here we compare short- and long-term blood pressure (BP)-lowering effects of renal denervation (RDN) between hypertensive patients with or without CKD in the Global SYMPLICITY Registry. Methods Office and 24-h ambulatory BP (ABP) were assessed at prespecified time points after RDN. The presence of CKD was defined according to the estimated glomerular filtration rate (eGFR) and enrolled patients were stratified based on the presence (n = 475, eGFR 60 mL/min/1.73 m2) or absence (n = 1505, eGFR ≥60mL/min/1.73 m2) of CKD. Results Patients with CKD were older (P 0.001) and were prescribed more antihypertensive medications (P 0.001). eGFR decline per year was not significantly different between groups after the first year. Office and 24-h ABP were significantly reduced from baseline at all time points after RDN in both groups (all P 0.001). After adjusting for baseline data, patients without CKD had a greater reduction in office systolic BP (−17.3 ± 28.3 versus −11.7 ± 29.9 mmHg; P = 0.009) but not diastolic BP at 36 months compared with those with CKD. Similar BP and eGFR results were found when the analysis was limited to patients with both baseline and 36-month BP data available. There was no difference in the safety profile of the RDN procedure between groups. Conclusions After adjusting for baseline data, 24-h systolic and diastolic ABP reduction were similar in patients with and without CKD after RDN, whereas office systolic but not diastolic BP was reduced less in patients with CKD. We conclude that RDN is an effective antihypertensive treatment option in CKD patients.

Ask AI

Helpful

Bookmark