Renal Denervation in Moderate to Severe CKD

TLDR

Sympathetic activation drives CKD progression and cardiovascular risk, and while renal denervation lowers blood pressure in patients with preserved kidney function, its safety and efficacy in those with eGFR < 45 ml/min remain uncertain. The study performed bilateral renal denervation on 15 patients with stage 3–4 CKD (mean eGFR 31 ml/min) and employed CO₂ angiography in six cases to limit contrast exposure. Renal denervation was safe, with no change in eGFR, and produced sustained reductions in office and nighttime blood pressure, improving dipping patterns in patients with stage 3–4 CKD and resistant hypertension.

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 m2 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 m2). We used CO2 angiography in six patients to minimize exposure to contrast agents. Estimated GFR remained unchanged after the procedure, irrespective of the use of CO2 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.