Lessons Learned from RADIOSOUND-HTN: Different Technologies and Techniques for Catheter-based Renal Denervation and Their Effect on Blood Pressure

Lurz, Philipp; Fengler, Karl

doi:10.15420/icr.2019.03.r1

Cited by 5 publications

(1 citation statement)

References 32 publications

(44 reference statements)

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“…In both procedures, the renal artery is accessed via the common femoral artery after selective renal angiography and placement of a 0.014″ guidewire in the renal arteries. It is worth highlighting that despite rRDN is designed to treat both the main and distal renal arteries while uRDN specifically the main renal arteries, the efficacy of both procedures is comparable [ 68 •, 69 ].…”

Section: Renal Denervation: Devices and Modalitiesmentioning

confidence: 99%

Does Renal Denervation a Reasonable Treatment Option in Hemodialysis-Dependent Patient with Resistant Hypertension? A Narrative Review

Mazza,

Dell’Avvocata,

Torin

et al. 2023

Curr Hypertens Rep

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Purpose of Review This narrative review aims to assess the pathophysiology, diagnosis, and treatment of resistant hypertension (RH) in end-stage kidney disease (ESKD) patients on dialysis, with a specific focus on the effect of renal denervation (RDN) on short-term and long-term blood pressure (BP) control. Additionally, we share our experience with the use of RDN in an amyloidotic patient undergoing hemodialysis with RH. Recent Findings High BP, an important modifiable cardiovascular risk factor, is often observed in patients in ESKD, despite the administration of multiple antihypertensive medications. However, in clinical practice, it remains challenging to identify RH patients on dialysis treatment because of the absence of specific definition for RH in this context. Moreover, the use of invasive approaches, such as RDN, to treat RH is limited by the exclusion of patients with reduced renal function (eGFR < 45 mL/min/1.73 m3) in the clinical trials. Nevertheless, recent studies have reported encouraging results regarding the effectiveness of RDN in stage 3 and 4 chronic kidney disease (CKD) and ESKD patients on dialysis, with reductions in BP of nearly up to 10 mmhg. Summary Although multiple underlying pathophysiological mechanisms contribute to RH, the overactivation of the sympathetic nervous system in ESKD patients on dialysis plays a crucial role. The diagnosis of RH requires both confirmation of adherence to antihypertensive therapy and the presence of uncontrolled BP values by ambulatory BP monitoring or home BP monitoring. Treatment involves a combination of nonpharmacological approaches (such as dry weight reduction, sodium restriction, dialysate sodium concentration reduction, and exercise) and pharmacological treatments. A promising approach for managing of RH is based on catheter-based RDN, through radiofrequency, ultrasound, or alcohol infusion, directly targeting on sympathetic overactivity.

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Section: Renal Denervation: Devices and Modalitiesmentioning

confidence: 99%

Does Renal Denervation a Reasonable Treatment Option in Hemodialysis-Dependent Patient with Resistant Hypertension? A Narrative Review

Mazza,

Dell’Avvocata,

Torin

et al. 2023

Curr Hypertens Rep

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Metabolic effects two years after renal denervation in insulin resistant hypertensive patients. The Re-Shape CV-risk study

et al. 2021

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Blood pressure reduction after renal denervation in patients with or without chronic kidney disease

Günes-Altan,

Schmid,

Ott

et al. 2023

Clinical Kidney Journal

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Background Renal denervation (RDN) has emerged as an adjacent option for the treatment of hypertension. This analysis of the ERLANGER registry aimed of comparing the blood pressure (BP) lowering effects and safety of RDN in patients with and without chronic kidney disease (CKD). Methods In this single center retrospective analysis, 47 patients with and 127 without CKD underwent radiofrequency, ultrasound or alcohol-infusion based RDN. Office and 24-h ambulatory BP and estimated Glomerular Filtration Rate (eGFR) were measured at baseline, after 6 and 12 months. Results 174 patients with a mean age of 59.0 ± 10 years were followed up for 12 months. At baseline mean eGFR was 55.8± 21 ml/min/1.73m² in patients with CKD and 87.3± 13 ml/min/1.73m² in patients without CKD. There was no significant eGFR decline in either of the groups during 12 months follow up. In patients without CKD, office systolic and diastolic BP were reduced by -15.3 ± 17.5/-7.9 ± 10.8 mmHg 6 months after RDN and by -16.1 ± 18.2/-7.7 ± 9.6 mmHg 12 months after RDN. In patients with CKD, office systolic and diastolic BP were reduced by -10.7 ± 24.0/-5.8 ± 13.2 mmHg 6 months after RDN and by -15.1 ± 24.9/-5.9 ± 12.9 mmHg 12 months after RDN. Accordingly, in patients without CKD, 24-h ambulatory systolic and diastolic BP were reduced by -7.2 ± 15.8/-4.9 ± 8.8 mmHg 6 months after RDN and by -9.0 ± 17.0/-6.2 ± 9.8 mmHg 12 months after RDN. In patients with CKD, 24-h systolic and diastolic BP were reduced by -7.4 ± 12.9/-4.2 ± 9.9 mmHg 6 months after RDN and by -8.0 ± 14.0/-3.6 ± 9.6 mmHg 12 months after RDN. There was no difference in the reduction of office and 24-h ambulatory BP between the 2 groups at any time point (all p > 0.2). Similar results have been found for the 6 months data. With exception of rare local adverse events, we did not observe any safety signals. Conclusion According to our single center experience, we observed a similar reduction in 24-h, day and night-time ambulatory BP as well as in office BP in patients with and without CKD at any time point up to 12 months. We conclude that RDN is an effective and safe treatment option for patients with hypertension and CKD.

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Lessons Learned from RADIOSOUND-HTN: Different Technologies and Techniques for Catheter-based Renal Denervation and Their Effect on Blood Pressure

Cited by 5 publications

References 32 publications

Does Renal Denervation a Reasonable Treatment Option in Hemodialysis-Dependent Patient with Resistant Hypertension? A Narrative Review

Does Renal Denervation a Reasonable Treatment Option in Hemodialysis-Dependent Patient with Resistant Hypertension? A Narrative Review

Metabolic effects two years after renal denervation in insulin resistant hypertensive patients. The Re-Shape CV-risk study

Blood pressure reduction after renal denervation in patients with or without chronic kidney disease

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