Favorable effect of renal denervation on elevated renal vascular resistance in patients with resistant hypertension and type 2 diabetes mellitus

Abstract

ObjectiveTo assess the effect of renal denervation (RDN) on renal vascular resistance and renal function in patients with drug-resistant hypertension (HTN) and type 2 diabetes mellitus (T2DM).Materials and methodsFifty-nine patients (mean age 60.3 ± 7.9 years, 25 men) with resistant HTN [mean 24-h ambulatory blood pressure (BP) 158.0 ± 16.3/82.5 ± 12.7 mmHg, systolic/diastolic] and T2DM (mean HbA1c 7.5 ± 1.5%) were included in the single-arm prospective study and underwent RDN. Renal resistive index (RRI) derived from ultrasound Doppler; estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula), office and 24-h ambulatory BP were measured at baseline, 6, and 12 months after RDN to evaluate the respective changes in renal vascular resistance, renal function, and BP during treatment.ResultsForty-three patients completed 12 months follow-up. The RRI changed depending on the baseline value. Specifically, the RRI decreased significantly in patients with elevated baseline RRI values ≥ 0.7 {n = 23; −0.024 [95% confidence interval (CI): −0.046, −0.002], p = 0.035} and did not change in those with baseline RRI < 0.7 [n = 36; 0.024 (95% CI: −0.002, 0.050), p = 0.069]. No significant change was observed in eGFR whereas BP was significantly reduced at 12 months after RDN by −10.9 (95% CI: −16.7, −5.0)/−5.5 (95% CI: −8.7, −2.4) mmHg, systolic/diastolic. No relationship was found between the changes in RRI and BP.ConclusionOur study shows that RDN can decrease elevated renal vascular resistance (RRI > 0.7) and stabilize kidney function in patients with RHTN and T2DM independently of its BP-lowering effect.

Long-term outcomes of renal denervation in the treatment of comorbid patients with hypertension, diabetes and coronary atherosclerosis

“…Целью последующего проспективного исследования стала оценка отсроченных эффектов РДН (через 12 мес.) на динамику почечного сосудистого сопротивления, СКФ и АД [27]. Согласно данному исследованию, РДН значимо снижает почечное сосудистое сопротивление у пациентов с исходно высоким значением данного показателя (>0,7).…”

Promising areas of renal denervation application

“…При этом в течение 12 мес. уровень СКФ оставался стабильным, что отражает важное значение РДН в замедлении прогрессирования нефропатии и безопасности данной процедуры [21]. По результатам метаанализа, включавшего 238 пациентов после РДН, СКФ значимо не снижалась за период наблюдения вплоть до 2 лет после процедуры [22].…”