title: Feasibility of catheter-based renal nerve ablation and effects on sympathetic nerve activity and blood pressure in patients with end-stage renal disease.
abstract: OBJECTIVE
  Sympathetic activation is a hallmark of ESRD and adversely affects cardiovascular prognosis. Efferent sympathetic outflow and afferent neural signalling from the failing native kidneys are key mediators and can be targeted by renal denervation (RDN). Whether this is feasible and effective in ESRD is not known.
  
  
  METHODS
  In an initial safety and proof-of-concept study we attempted to perform RDN in 12 patients with ESRD and uncontrolled blood pressure (BP). Standardized BP measurements were obtained in all patients on dialysis free days at baseline and follow up. Measures of renal noradrenaline spillover and muscle sympathetic nerve activity were available from 5 patients at baseline and from 2 patients at 12 month follow up and beyond.
  
  
  RESULTS
  Average office BP was 170.8 ± 16.9/89.2 ± 12.1 mmHg despite the use of 3.8 ± 1.4 antihypertensive drugs. All 5 patients in whom muscle sympathetic nerve activity and noradrenaline spillover was assessed at baseline displayed substantially elevated levels. Three out of 12 patients could not undergo RDN due to atrophic renal arteries. Compared to baseline, office systolic BP was significantly reduced at 3, 6, and 12 months after RDN (from 166 ± 16.0 to 148 ± 11, 150 ± 14, and 138 ± 17 mmHg, respectively), whereas no change was evident in the 3 non-treated patients. Sympathetic nerve activity was substantially reduced in 2 patients who underwent repeat assessment.
  
  
  CONCLUSIONS
  RDN is feasible in patients with ESRD and associated with a sustained reduction in systolic office BP. Atrophic renal arteries may pose a problem for application of this technology in some patients with ESRD.
authors: Neurovascular Hypertension & Kidney Disease and Human Neurotransmitters Laboratories Baker IDI Heart & Diabetes Institute, Alfred Hospital, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences and Department of Physiology, Monash University, Melbourne, Victoria, Australia. Electronic address: markus.schlaich@bakeridi.edu.au.
authors: Markus P
authors: MP
authors: Schlaich
authors: Bradley
authors: B
authors: Bart
authors: Dagmara
authors: D
authors: Hering
authors: Anthony
authors: A
authors: Walton
authors: Petra
authors: P
authors: Marusic
authors: Felix
authors: F
authors: Mahfoud
authors: Michael
authors: M
authors: Böhm
authors: Elisabeth A
authors: EA
authors: Lambert
authors: Henry
authors: H
authors: Krum
authors: Paul A
authors: PA
authors: Sobotka
authors: Roland E
authors: RE
authors: Schmieder
authors: Carolina
authors: C
authors: Ika-Sari
authors: Nina
authors: N
authors: Eikelis
authors: Nora
authors: N
authors: Straznicky
authors: Gavin W
authors: GW
authors: Lambert
authors: Murray D
authors: MD
authors: Esler
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: End-stage renal disease; Hypertension; Renal denervation; Sympathetic