title: Renal denervation in moderate to severe CKD.
abstract: Sympathetic activation contributes to the progression of CKD and is associated with adverse cardiovascular outcomes. Ablation of renal sympathetic nerves reduces sympathetic nerve activity and BP in patients with resistant hypertension and preserved renal function, but whether this approach is safe and effective in patients with an estimated GFR (eGFR) < 45 ml/min per 1.73 m(2) is unknown. We performed bilateral renal denervation in 15 patients with resistant hypertension and stage 3-4 CKD (mean eGFR, 31 ml/min per 1.73 m(2)). We used CO(2) angiography in six patients to minimize exposure to contrast agents. Estimated GFR remained unchanged after the procedure, irrespective of the use of CO(2) angiography. Mean baseline BP ± SD was 174 ± 22/91 ± 16 mmHg despite the use of 5.6 ± 1.3 antihypertensive drugs. Mean changes in office systolic and diastolic BP at 1, 3, 6, and 12 months were -34/-14, -25/-11, -32/-15, and -33/-19 mmHg, respectively. Night-time ambulatory BP significantly decreased (P<0.05), restoring a more physiologic dipping pattern. In conclusion, this study suggests a favorable short-term safety profile and beneficial BP effects of catheter-based renal nerve ablation in patients with stage 3-4 CKD and resistant hypertension.
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Hering
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Antony S
authors.initials: AS
authors.lastname: Walton
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Lambert
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Lambert
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Bodo
authors.initials: B
authors.lastname: Cremers
authors.forename: Murray D
authors.initials: MD
authors.lastname: Esler
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schlaich
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology / Q000601:surgery; D007668:Kidney / Q000294:innervation*; D007674:Kidney Diseases / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012720:Severity of Illness Index; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome