Renal denervation in moderate to severe CKD

Dagmara Hering, Felix Mahfoud, Antony S. Walton, Henry Krum, Gavin W. Lambert, Elisabeth A. Lambert, Paul A. Sobotka, Michael Böhm, Bodo Cremers, Murray D. Esler, Markus P. Schlaich

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Abstract

Sympathetic activation contributes to the progression of CKD and is associated with adverse cardiovascular outcomes. Ablation of renal sympathetic nerves reduces sympathetic nerve activity and BP in patients with resistant hypertension and preserved renal function, but whether this approach is safe and effective in patients with an estimated GFR (eGFR) < 45 ml/min per 1.73 m 2 is unknown. We performed bilateral renal denervation in 15 patients with resistant hypertension and stage 3-4 CKD (mean eGFR, 31 ml/min per 1.73 m 2). We used CO 2 angiography in six patients to minimize exposure to contrast agents. Estimated GFR remained unchanged after the procedure, irrespective of the use of CO 2 angiography. Mean baseline BP ± SD was 174±22/91±16 mmHg despite the use of 5.6±1.3 antihypertensive drugs. Mean changes in office systolic and diastolic BP at 1, 3, 6, and 12 months were -34/-14, -25/-11, -32/-15, and -33/-19 mmHg, respectively. Night-time ambulatory BP significantly decreased (P<0.05), restoring a more physiologic dipping pattern. In conclusion, this study suggests a favorable short-term safety profile and beneficial BP effects of catheter-based renal nerve ablation in patients with stage 3-4 CKD and resistant hypertension.

Original languageEnglish
Pages (from-to)1250-1257
Number of pages8
JournalJournal of the American Society of Nephrology
Volume23
Issue number7
DOIs
Publication statusPublished - 1 Jul 2012
Externally publishedYes

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Hering, D., Mahfoud, F., Walton, A. S., Krum, H., Lambert, G. W., Lambert, E. A., ... Schlaich, M. P. (2012). Renal denervation in moderate to severe CKD. Journal of the American Society of Nephrology, 23(7), 1250-1257. https://doi.org/10.1681/ASN.2011111062