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

Abstract

In patients with end-stage renal disease (ESRD) undergoing haemodialysis, hypertension is of common detection and frequently inadequately controlled. Multiple pathophysiological mechanisms are involved in the development and progression of the ESRD-related high blood pressure state, which has been implicated in the increased cardiovascular risk reported in this hypertensive clinical phenotype. Renal sympathetic efferent and afferent nerves play a relevant role in the development and progression of elevated blood pressure values in patients with ESRD, often leading to resistant hypertension. Catheter-based bilateral renal nerves ablation has been shown to exert blood pressure lowering effects in resistant hypertensive patients with normal kidney function. Promising data on the procedure in ESRD patients with resistant hypertension have been reported in small scale pilot studies. Denervation of the native non-functioning kidney’s neural excitatory influences on central sympathetic drive could reduce the elevated cardiovascular morbidity and mortality seen in ESRD patients. The present review article will focus on the promising results obtained with renal denervation in patients with ESRD, its mechanisms of action and future perspectives in these high risk patients.

The Global Burden of Resistant Hypertension and Potential Treatment Options

“…Identifying individuals who are more likely to respond positively to renal denervation, such as those not included in RCTs because of advanced CKD, becomes crucial. [ 128 ] In addition, performing such procedures demands operators with proficiency in renal interventions and specialised training. Centres offering renal denervation should possess the capability to address any potential complications.…”