Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease: a meta-analysis

Abstract

Background: Renal denervation (RDN) is a new treatment for hypertension in patients with chronic kidney disease (CKD), but its efficacy is still debated. This meta-analysis aimed to evaluate the efficacy and safety of RDN for hypertension in patients with CKD. Methods: PubMed, Web of Science, EMBASE, and Ovid databases were searched for relevant studies published. We performed both fixed-and random-effects meta-analyses of the changes in blood pressure, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (UACR) after RDN. Results: The meta-analysis included 238 patients from 11 single-center, non-randomized, uncontrolled studies. Office blood pressure and 24-hour ambulatory blood pressure (24 h-ABP) showed a significant reduction 1 month after RDN (p < 0.05). This decrease of 24 h-ABP persisted for 24 months after RDN showed difference systolic blood pressure (p < 0.001) and diastolic blood pressure (p ¼ 0.001). The 24 h-ABP exhibited a similar trend in the subgroup analysis. eGFR measurements obtained at each time point of analysis after RDN were not significantly different from those obtained before (p > 0.05). UACR levels were significantly reduced at 3 months and 6 months after RDN (p < 0.001). After RDN, the heart rate showed no significant changes (p > 0.05), and few major complications were encountered. Conclusions: The meta-analysis showed that RDN may be effective and safe for treating CKD patients with hypertension. Well-designed randomized controlled trials of RDN are urgently needed to confirm the safety and reproducibility of RDN and to assess its impact on clinical outcomes.

Renal denervation for atrial fibrillation: a comprehensive updated systematic review and meta-analysis

“…The treatment efforts to dampen RAAS clinically, such as with pharmacological therapy, have failed to yield significant improvements in eGFR and CKD [ 41 ]. The progression demonstrated by RDN has led to multiple investigations on the topic and a recent meta-analysis of 11 non-randomized studies was conducted, looking at the effect of RDN in hypertensive patients with CKD [ 42 ]. The study mainly concluded that RDN was superior in reducing blood pressure and had no increase in the rate of decline in renal function in patients with CKD.…”

Renal Denervation in End-Stage Renal Disease: Current Evidence and Perspectives

“…Collectively, to date, a unique meta-analysis has been conducted, focusing on impact of renal denervation in 238 resistant hypertensive patients with CKD/ESRD. This analysis encompassed not only patients undergoing haemodialysis but also those with CKD stages 1–5, drawing data from 11 single-center studies, non-randomized, uncontrolled [ 46 ]. The results revealed that RDN exhibited effectiveness in reducing both office and 24-h ambulatory blood pressure over a time span of at least 24 months [ 46 ].…”

Renal denervation in patients with chronic kidney disease: current evidence and future perspectives

“…The renal denervation procedure is effective in hypertensive patients with CKD: in the meta-analysis in 2021 of single-centre studies on patients with CKD [ 45 ], office BP and 24-h ambulatory BP were significantly reduced from baseline to 1 month ( P < .05) and sustained for at least 24 months. A recent analysis of 3-year follow-up data from the Global Symplicity Registry included 475 subjects with CKD [baseline estimated GFR (eGFR) <60 mL/min/1.73 m 2 but ≥15 mL/min/1.73 m 2 ] versus 1505 subjects without CKD (baseline eGFR ≥60 mL/min/1.73 m 2 ) [ 46 ].…”

“…Given the lack of RCT data, what is available comes mostly from small, isolated studies. A meta-analysis of procedure-related events in 238 patients from 11 single-centre, non-randomized, uncontrolled trials found low rates of haematoma (2.9%) and pseudoaneurysm (1.3%) [ 45 ]. In the retrospective analysis of 3-year follow-up data from the Global Symplicity Registry, there were no differences in safety outcomes between subjects with and without CKD, with rates of renal artery stenosis <0.5% [ 46 ].…”