Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension.
OBJECTIVE
Arterial hypertension and increased sympathetic activity are underlying pathogenetic mechanisms of the progressive loss of renal function in patients with chronic kidney disease (CKD). Meta-analyses have shown that impaired renal function is an independent cardiovascular risk factor. We hypothesized that renal denervation (RDN) decreases the decline of renal function in patients with CKD stages 3 and 4 and treatment-resistant hypertension.


METHODS
We performed an observational study of 27 patients with CKD stages 3 and 4, office blood pressure (BP) ≥ 140/90 mmHg, while on at least three antihypertensive drug classes including diuretic, and diagnosis confirmed by 24-h ambulatory BP measurement ≥ 130/80 mmHg. All patients underwent catheter-based RDN using the Symplicity Flex RDN System (Medtronic Inc., Santa Rosa, California, USA). Renal function was evaluated for up to 3 years prior and 1 year after RDN. The change in estimated glomerular filtration rate (eGFR) was calculated by regression slope individually for each patient before and after RDN. The study was registered at http://www.clinicaltrials.gov (ID: NCT01442883).


RESULTS
Mean baseline BP was 156 ± 12/82 ± 13 mmHg, despite treatment with 6.2 ± 1.1 antihypertensive drugs. One year after RDN, office BP was reduced by 20 ± 20 (P < 0.001)/8 ± 14 mmHg (P = 0.005) and average 24-h ambulatory BP by 9 ± 14 (P = 0.009)/4 ± 7 mmHg (P = 0.019). Before RDN, eGFR declined by -4.8 ± 3.8 ml/min per 1.73 m per year, and after RDN eGFR improved by +1.5 ± 10 ml/min per 1.73 m at 12 months (P = 0.009).


CONCLUSIONS
Our observational pilot study in patients with CKD stages 3 and 4 indicates that treatment of hypertension with RDN decreases BP and slows or even halts the decline of renal function.
aDepartment of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen bKlinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar cDepartment of Radiology, University of Erlangen-Nuremberg, Erlangen dDepartment of Forensic Toxicology, Institute of Legal Medicine, Goethe University, Frankfurt/Main, Germany.
Christian
C
Ott
Felix
F
Mahfoud
Axel
A
Schmid
Stefan W
SW
Toennes
Sebastian
S
Ewen
Tilmann
T
Ditting
Roland
R
Veelken
Christian
C
Ukena
Michael
M
Uder
Michael
M
Böhm
Roland E
RE
Schmieder
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002140:California; D002318:Cardiovascular Diseases / Q000175:diagnosis; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors; D013562:Sympathectomy; D013565:Sympatholytics / Q000627:therapeutic use; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D004232:Diuretics; D013565:Sympatholytics