title: Renal denervation in multiple renal arteries.
abstract: BACKGROUND
  In most previous studies investigating efficacy of renal denervation (RDN), patients with multiple renal arteries are generally excluded from treatment. This study was designed to determine the prevalence of multiple renal arteries in patients referred for RDN, to propose a classification for anatomical eligibility and to investigate the relation between the presence of multiple arteries and blood pressure (BP)-lowering effect.
  
  
  METHODS
  Patients referred for RDN who underwent noninvasive imaging of the renal arteries before treatment were included in present analysis. Eligible patients were treated. Renal function and BP were evaluated 6 months after treatment.
  
  
  RESULTS
  Hundred and twenty-six patients referred for RDN were included in present analysis. Thirty-four per cent had multiple arteries. Sixty-nine patients underwent RDN. Office BP significantly reduced from 195 (± 26)/106 (± 14) mmHg to 165 (± 24)/95 (± 14) mmHg (P < 0·001). BP reduction in patients with multiple arteries which were all treated was comparable to patients with solitary arteries. However, patients with multiple which were not all treated showed a trend towards a less pronounced effect of RDN (β: 11·6, P = 0·11). The proposed classification appeared useful by identifying eligible anatomy. Renal function at 6 months did not differ from baseline in all subgroups.
  
  
  CONCLUSIONS
  Based on our results and the high prevalence of multiple arteries, it seems reasonable not to exclude patients with multiple renal arteries from RDN. Current analysis suggests that BP reduction may be less pronounced in patients with multiple renal arteries of whom not all arteries were treated.
authors.affiliation: Department of Cardiology, University Medical Center, Utrecht, the Netherlands.
authors.forename: Willemien L
authors.initials: WL
authors.lastname: Verloop
authors.forename: Eva E
authors.initials: EE
authors.lastname: Vink
authors.forename: Wilko
authors.initials: W
authors.lastname: Spiering
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Evert-Jan
authors.initials: EJ
authors.lastname: Vonken
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012077:Renal Artery / Q000002:abnormalities*; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Blood pressure; multiple arteries; renal denervation