title: Effect of renal denervation on kidney function in patients with chronic kidney disease.
abstract: OBJECTIVE
  Renal denervation (RDN) can reduce blood pressure (BP) and slow the decline of renal function in chronic kidney disease (CKD) up to one year. Whether this effect is maintained beyond 12months and whether the magnitude of BP reduction affects estimated glomerular filtration rate (eGFR) is unknown.
  
  
  RESULTS
  We examined eGFR in 46 CKD patients (baseline eGFR ≤60mL/min/1.73m2) on a yearly basis from 60months before to 3, 6, 12 and 24months after RDN. Ambulatory BP was measured before and after RDN. Linear mixed models analysis demonstrated a significant progressive decline in eGFR from months 60 to 12months (-15.47±1.98mL/min/1.73m2, P<0.0001) and from 12months to baseline prior to RDN (-3.41±1.64mL/min/1.73m2, P=0.038). Compared to baseline, RDN was associated with improved eGFR at 3months (+3.73±1.64mL/min/1.73m2, P=0.02) and no significant changes at 6 (+2.54±1.66mL/min/1.73m2, P=0.13), 12 (+1.78±1.64mL/min/1.73m2, P=0.28), and 24 (-0.24±2.24mL/min/1.73m2, P=0.91) months post procedure were observed. RDN significantly reduced daytime SBP from baseline to 24months post procedure (148±19 vs 136±17mmHg, P=0.03) for the entire cohort. Changes in SBP were unrelated to the eGFR changes at 6 (r=0.033, P=0.84), 12 (r=0.01, P=0.93) and 24months (r=-0.42, P=0.17) follow-up.
  
  
  CONCLUSIONS
  RDN can slow further deterioration of renal function irrespective of BP lowering effects in CKD. RDN-induced inhibition of sympathetic outflow to the renal vascular bed may account for improved eGFR via alterations of intrarenal and glomerular hemodynamics.
authors.affiliation: School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Hering
authors.affiliation: School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia.
authors.forename: Petra
authors.initials: P
authors.lastname: Marusic
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Duval
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sata
authors.affiliation: Neuropharmacology Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Head
authors.affiliation: Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Denton
authors.affiliation: School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Burrows
authors.affiliation: Heart Centre Alfred Hospital, Melbourne, Australia.
authors.forename: Antony S
authors.initials: AS
authors.lastname: Walton
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre Alfred Hospital, Melbourne, Australia.
authors.forename: Murray D
authors.initials: MD
authors.lastname: Esler
authors.affiliation: School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia; Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre Alfred Hospital, Melbourne, Australia. Electronic address: markus.schlaich@uwa.edu.au.
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schlaich
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Blood pressure; Chronic kidney disease; Renal denervation; Renal function