title: Renal denervation in a hypertensive patient with end-stage renal disease and small arteries: a direction for future research.
abstract: Sympathetic overactivity plays a crucial pathogenetic role in the maintenance and aggravation of arterial hypertension in patients with end-stage renal disease (ESRD). Renal denervation has been shown to be effective and safe in reducing blood pressure (BP) in patients with treatment-resistant hypertension; however, there are only case reports in hypertensive patients with ESRD and data are lacking about possibility of renal denervation in small renal arteries. A woman with uncontrolled treatment-resistant hypertension on chronic hemodialysis underwent bilateral native kidney, catheter-based renal denervation. Both native renal arteries were <4 mm. After 6 months without any change of antihypertensive medication or hemodialysis parameters, the authors observed a remarkable BP reduction of 38/30 mm Hg (from baseline 172/100 mm Hg to 134/70 mm Hg) as evaluated by 24-hour ambulatory BP monitoring. The authors report that renal denervation seems to be effective in controlling hypertension in patients with ESRD, even in cases of small renal arteries.
authors.affiliation: Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Axel
authors.initials: A
authors.lastname: Schmid
authors.forename: Tilmann
authors.initials: T
authors.lastname: Ditting
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Roland
authors.initials: R
authors.lastname: Veelken
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000328:Adult; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D007668:Kidney / Q000294:innervation*; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000628:therapy*; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006435:Renal Dialysis