Renal Sympathetic Denervation in Patients With Hypertension and Chronic Kidney Disease: Does Improvement in Renal Function Follow Blood Pressure Control?

Abstract

Twenty‐seven patients with resistant hypertension and chronic kidney disease were treated by renal sympathetic denervation (RSD) and followed for 12 months. Patients were retrospectively divided into controlled and uncontrolled blood pressure (BP) groups. Increases in mean estimated glomerular filtration rate (eGFR) were found at months 1, 3, 6, and 12 in the controlled group (P<.0001, for every time point). The mean change in eGFR after 12 months was 18.54±8.15 mL/min/1.73m2 higher in the controlled group (P=.0318). In patients in the controlled group with baseline eGFR <45 mL/min/1.73 m2, responders (with an increase in eGFR >6.2%) corresponded to 50% at 6 months and 83% at 12 months. In the patients with baseline eGFR ≥45 mL/min/1.73 m2, all patients were labeled as responders at months 6 and 12. Median albumin:creatinine ratio after 12 months was lower than baseline only in the controlled group (P=.0003). Our results suggest that patients with this profile who reached BP control by RSD also experienced a significant improvement in renal function.

Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients - diastolic function

“…This procedure has also proved effective in controlling resistant hypertension even in patients with CKD. In two studies with a short follow-up period, the RSD was associated with increased eGFR [31,34,35] and the reduction of albuminuria [31,34,36]. Our data confirm the results of previous studies in relation to improving the office BP, 24-hour ABPM, number of antihypertensive drugs, creatinine values, eGFR and ACR, at the 6 th month post procedure.…”

“…As it is already known he control of BP reduces the rate of progression of CKD [31] and RSD is a powerful method for the control of resistant hypertension [32,33]. This procedure has also proved effective in controlling resistant hypertension even in patients with CKD.…”

Improvement of the renal function after renal sympathetic denervation in refractory hypertensive patients with chronic kidney disease: Possible predictors

“…Recently, Ott et al reported an observational pilot study in patients with CKD stages 3 and 4 which indicates that treatment of hypertension with renal sympathetic denervation (RSD) decreases BP and slows or even halts the decline of renal function [2], in agreement with our previous results that showed BP control and an increase in estimated glomerular filtration rate (eGFR), especially in the mild stages of CKD [3][4][5], after RSD. Subjects that were considered responders to RSD regarding renal function presented changes in eGFR with order of magnitude higher than 6.2% [4].…”

Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

“…As we described previously [5,6], the reduction in office BP was evident from the 1st month until one year after RSD in refractory hypertensive patients. A recent study in animals showed the pathology of radiofrequencyderived RSD during the time and provided important knowledge of the mechanisms resulting in sustained BP reduction, and reported that the nerve damage post radiofrequency ablation was greatest at 7 days, with maximum functional nerve damage sustained ≤30 days.…”