Renal denervation in moderate to severe CKD

Area of Science:

• Nephrology
• Cardiology
• Interventional Cardiology

Background:

• Sympathetic nervous system overactivity accelerates chronic kidney disease (CKD) progression and is linked to poor cardiovascular outcomes.
• Renal sympathetic denervation effectively lowers blood pressure (BP) in resistant hypertension with preserved kidney function.
• The safety and efficacy of renal denervation in patients with reduced estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m² remain largely unknown.

Purpose of the Study:

• To evaluate the safety and efficacy of catheter-based renal nerve ablation in patients suffering from resistant hypertension and stage 3-4 CKD.
• To assess the impact of renal denervation on blood pressure control and renal function in this specific patient cohort.

Main Methods:

• Bilateral renal denervation was performed in 15 patients with resistant hypertension and stage 3-4 CKD (mean eGFR: 31 ml/min/1.73 m²).
• CO2 angiography was utilized in six patients to minimize contrast agent exposure.
• Blood pressure was monitored through office and 24-hour ambulatory measurements, alongside assessment of estimated GFR.

Main Results:

• Renal denervation demonstrated a favorable short-term safety profile, with no significant changes in estimated GFR.
• Significant reductions in both systolic and diastolic blood pressure were observed at multiple time points up to 12 months post-procedure.
• Night-time ambulatory BP decreased significantly, leading to a more physiological dipping pattern.

Conclusions:

• Catheter-based renal nerve ablation appears to be a safe and effective short-term treatment for reducing blood pressure in patients with stage 3-4 CKD and resistant hypertension.
• The findings suggest that renal denervation can be considered as a therapeutic option for improving BP control in patients with advanced CKD and difficult-to-manage hypertension.