Effect of renal denervation on kidney function in patients with chronic kidney disease

Dagmara Hering, Petra Marusic, Jacqueline Duval, Yusuke Sata, Geoffrey A. Head, Kate M. Denton, Sally Burrows, Antony S. Walton, Murray D. Esler, Markus P. Schlaich

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    Abstract

    Aims 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 12 months and whether the magnitude of BP reduction affects estimated glomerular filtration rate (eGFR) is unknown. Methods and results We examined eGFR in 46 CKD patients (baseline eGFR ≤ 60 mL/min/1.73m2) on a yearly basis from 60 months before to 3, 6, 12 and 24 months 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 12 months (− 15.47 ± 1.98 mL/min/1.73m2, P < 0.0001) and from 12 months to baseline prior to RDN (− 3.41 ± 1.64 mL/min/1.73m2, P = 0.038). Compared to baseline, RDN was associated with improved eGFR at 3 months (+ 3.73 ± 1.64 mL/min/1.73m2, P = 0.02) and no significant changes at 6 (+ 2.54 ± 1.66 mL/min/1.73m2, P = 0.13), 12 (+ 1.78 ± 1.64 mL/min/1.73m2, P = 0.28), and 24 (− 0.24 ± 2.24 mL/min/1.73m2, P = 0.91) months post procedure were observed. RDN significantly reduced daytime SBP from baseline to 24 months post procedure (148 ± 19 vs 136 ± 17 mm Hg, 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 24 months (r = − 0.42, P = 0.17) follow-up. Conclusion 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.

    Original languageEnglish
    Pages (from-to)93-97
    Number of pages5
    JournalInternational Journal of Cardiology
    Volume232
    DOIs
    Publication statusPublished - 1 Apr 2017

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    Denervation
    Chronic Renal Insufficiency
    Kidney
    Glomerular Filtration Rate
    Blood Pressure
    Blood Vessels
    Linear Models
    Hemodynamics

    Cite this

    Hering, Dagmara ; Marusic, Petra ; Duval, Jacqueline ; Sata, Yusuke ; Head, Geoffrey A. ; Denton, Kate M. ; Burrows, Sally ; Walton, Antony S. ; Esler, Murray D. ; Schlaich, Markus P. / Effect of renal denervation on kidney function in patients with chronic kidney disease. In: International Journal of Cardiology. 2017 ; Vol. 232. pp. 93-97.
    @article{ccc72fb46bba4e11b74c65be5bb3fec1,
    title = "Effect of renal denervation on kidney function in patients with chronic kidney disease",
    abstract = "Aims 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 12 months and whether the magnitude of BP reduction affects estimated glomerular filtration rate (eGFR) is unknown. Methods and results We examined eGFR in 46 CKD patients (baseline eGFR ≤ 60 mL/min/1.73m2) on a yearly basis from 60 months before to 3, 6, 12 and 24 months 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 12 months (− 15.47 ± 1.98 mL/min/1.73m2, P < 0.0001) and from 12 months to baseline prior to RDN (− 3.41 ± 1.64 mL/min/1.73m2, P = 0.038). Compared to baseline, RDN was associated with improved eGFR at 3 months (+ 3.73 ± 1.64 mL/min/1.73m2, P = 0.02) and no significant changes at 6 (+ 2.54 ± 1.66 mL/min/1.73m2, P = 0.13), 12 (+ 1.78 ± 1.64 mL/min/1.73m2, P = 0.28), and 24 (− 0.24 ± 2.24 mL/min/1.73m2, P = 0.91) months post procedure were observed. RDN significantly reduced daytime SBP from baseline to 24 months post procedure (148 ± 19 vs 136 ± 17 mm Hg, 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 24 months (r = − 0.42, P = 0.17) follow-up. Conclusion 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.",
    keywords = "Blood pressure, Chronic kidney disease, Renal denervation, Renal function",
    author = "Dagmara Hering and Petra Marusic and Jacqueline Duval and Yusuke Sata and Head, {Geoffrey A.} and Denton, {Kate M.} and Sally Burrows and Walton, {Antony S.} and Esler, {Murray D.} and Schlaich, {Markus P.}",
    year = "2017",
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    doi = "10.1016/j.ijcard.2017.01.047",
    language = "English",
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    Effect of renal denervation on kidney function in patients with chronic kidney disease. / Hering, Dagmara; Marusic, Petra; Duval, Jacqueline; Sata, Yusuke; Head, Geoffrey A.; Denton, Kate M.; Burrows, Sally; Walton, Antony S.; Esler, Murray D.; Schlaich, Markus P.

    In: International Journal of Cardiology, Vol. 232, 01.04.2017, p. 93-97.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Effect of renal denervation on kidney function in patients with chronic kidney disease

    AU - Hering, Dagmara

    AU - Marusic, Petra

    AU - Duval, Jacqueline

    AU - Sata, Yusuke

    AU - Head, Geoffrey A.

    AU - Denton, Kate M.

    AU - Burrows, Sally

    AU - Walton, Antony S.

    AU - Esler, Murray D.

    AU - Schlaich, Markus P.

    PY - 2017/4/1

    Y1 - 2017/4/1

    N2 - Aims 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 12 months and whether the magnitude of BP reduction affects estimated glomerular filtration rate (eGFR) is unknown. Methods and results We examined eGFR in 46 CKD patients (baseline eGFR ≤ 60 mL/min/1.73m2) on a yearly basis from 60 months before to 3, 6, 12 and 24 months 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 12 months (− 15.47 ± 1.98 mL/min/1.73m2, P < 0.0001) and from 12 months to baseline prior to RDN (− 3.41 ± 1.64 mL/min/1.73m2, P = 0.038). Compared to baseline, RDN was associated with improved eGFR at 3 months (+ 3.73 ± 1.64 mL/min/1.73m2, P = 0.02) and no significant changes at 6 (+ 2.54 ± 1.66 mL/min/1.73m2, P = 0.13), 12 (+ 1.78 ± 1.64 mL/min/1.73m2, P = 0.28), and 24 (− 0.24 ± 2.24 mL/min/1.73m2, P = 0.91) months post procedure were observed. RDN significantly reduced daytime SBP from baseline to 24 months post procedure (148 ± 19 vs 136 ± 17 mm Hg, 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 24 months (r = − 0.42, P = 0.17) follow-up. Conclusion 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.

    AB - Aims 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 12 months and whether the magnitude of BP reduction affects estimated glomerular filtration rate (eGFR) is unknown. Methods and results We examined eGFR in 46 CKD patients (baseline eGFR ≤ 60 mL/min/1.73m2) on a yearly basis from 60 months before to 3, 6, 12 and 24 months 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 12 months (− 15.47 ± 1.98 mL/min/1.73m2, P < 0.0001) and from 12 months to baseline prior to RDN (− 3.41 ± 1.64 mL/min/1.73m2, P = 0.038). Compared to baseline, RDN was associated with improved eGFR at 3 months (+ 3.73 ± 1.64 mL/min/1.73m2, P = 0.02) and no significant changes at 6 (+ 2.54 ± 1.66 mL/min/1.73m2, P = 0.13), 12 (+ 1.78 ± 1.64 mL/min/1.73m2, P = 0.28), and 24 (− 0.24 ± 2.24 mL/min/1.73m2, P = 0.91) months post procedure were observed. RDN significantly reduced daytime SBP from baseline to 24 months post procedure (148 ± 19 vs 136 ± 17 mm Hg, 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 24 months (r = − 0.42, P = 0.17) follow-up. Conclusion 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.

    KW - Blood pressure

    KW - Chronic kidney disease

    KW - Renal denervation

    KW - Renal function

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    U2 - 10.1016/j.ijcard.2017.01.047

    DO - 10.1016/j.ijcard.2017.01.047

    M3 - Article

    VL - 232

    SP - 93

    EP - 97

    JO - International Journal of Cardiology

    JF - International Journal of Cardiology

    SN - 0167-5273

    ER -