title: Effects of renal denervation with a standard irrigated cardiac ablation catheter on blood pressure and renal function in patients with chronic kidney disease and resistant hypertension.
abstract: OBJECTIVE
  Evaluation of the safety and efficacy of renal denervation with a standard irrigated cardiac ablation catheter (SICAC) in chronic kidney disease (CKD) patients with refractory hypertension.
  
  
  RESULTS
  Twenty-four patients were included and treated with a SICAC. Denervation was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n = 16), 3 (n = 4), and 4 (n = 4). Data were obtained at baseline and monthly until 180th day of follow-up. Baseline values of blood pressure (mean ± SD) were 186 ± 19 mmHg/108 ± 13 mmHg in the office, and 151 ± 18 mmHg/92 ± 11 mmHg by 24 h ambulatory blood pressure monitoring (ABPM). Office blood pressure values at 180th day after the procedure were 135 ± 13 mmHg/88 ± 7 mmHg (P < 0.0001, for both comparisons). The mean ABPM decreased to 132 ± 15 mmHg/85 ± 11 mmHg at the 180th day after the procedure (P < 0.0001 for systolic and P = 0.0015 for diastolic). Estimated glomerular filtration (mean ± SD) increased from baseline (64.4 ± 23.9 mL/min/1.73 m(2)) to the 180th day (85.4 ± 34.9 mL/min/1.73 m(2), P < 0.0001) of follow-up. The median urine albumin:creatinine ratio decreased from baseline (48.5, IQR: 35.8-157.2 mg/g) to the 180th day after ablation (ACR = 15.7, IQR: 10.3-34.2 mg/g, P = 0.0017). No major complications were seen.
  
  
  CONCLUSIONS
  The procedure using SICAC seemed to be feasible, effective, and safe resulting in a better control of BP, a short-term increase in estimated glomerular filtration rate, and reduced albuminuria. Although encouraging, our data are preliminary and need to be validated in the long term.
authors.affiliation: Renal Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.
authors.forename: Márcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.forename: George Luiz Marques
authors.initials: GL
authors.lastname: Maia
authors.forename: Maria Angela Magalhães
authors.initials: MA
authors.lastname: de Queiroz Carreira
authors.forename: Tetsuaki
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.forename: Bruno Rustum
authors.initials: BR
authors.lastname: Andrea
authors.forename: Miguel Luis
authors.initials: ML
authors.lastname: Graciano
authors.forename: Jocemir Ronaldo
authors.initials: JR
authors.lastname: Lugon
mesh_terms: D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D003404:Creatinine / Q000378:metabolism; D004351:Drug Resistance; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine
keywords: Blood pressure reduction; Chronic kidney disease; Hypertension; Improvement of renal function; Renal denervation