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

Abstract

Supported by several high-quality randomised clinical trials and registry analyses, catheter-based renal denervation is becoming an important adjunctive treatment modality for the safe and efficacious treatment of hypertension besides lifestyle modifications and antihypertensive medication. Renal denervation is of particular interest to nephrologists as the intervention may provide additional benefits to hypertensive people with chronic kidney disease (CKD), a condition typically characterised by sympathetic hyperactivity. A growing body of clinical evidence supports the safety and efficacy of renal denervation in this difficult-to-control population. In addition, preclinical and clinical research indicate potential nephroprotective effects in CKD patients. The current review examines recent research on renal denervation with focus on renal disease and assesses the latest findings and their implications from a nephrologist's perspective.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…Efferent sympathetic nerves to the kidneys increase renin release via beta 1 -adrenergic receptor activation at the level of the juxta-glomerular cells, decrease renal perfusion and GFR, increase tubular reabsorption of sodium and induce a rightward shift of the BP-natriuresis curve. Conversely, increased afferent sensory nerve signaling to the central nervous system in response to kidney ischemia, injury or inflammatory, fibrotic processes and other alterations of the tissue environment leads to reflex sympathetic activation, with peripheral vasoconstriction, increased BP and aggravation of HMOD [765][766][767][768]. The rationale of RDN is to modulate the overactive signaling between the kidneys and the central SNS, which may be at least partly responsible for the sympathetic hyperactivity of resistant hypertension [720].…”

Diagnosis and management of resistant hypertension

“…Similarly, no evidence that renal denervation causes progression of decline in GFR has been found, with some evidence suggesting that it may offer renal protection. 136 Durability of effect has been shown over three years in clinical trials. 137 138 Promising longer term results have emerged from the Global Symplicity Registry 10 year follow-up study.…”

Sympathetic Nervous System and Atherosclerosis

“…Renal denervation is used to lower the blood pressure of hypertensive patients via the inhibition of sympathetic activity [99][100][101]. It may have beneficial effects in other indications beyond hypertension, such as renal failure [102,103] and atrial fibrillation [104].…”