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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Central Blood Pressure and Pulse Wave Velocity Changes Post Renal Denervation in Patients With Stages 3 and 4 Chronic
Bhanu Prasad1, Warren Berry2, Kunal Goyal3
1Section of Nephrology, Department of Medicine, Regina General Hospital, SK, Canada.
Insights
Renal denervation (RDN) significantly improved office blood pressures in patients with Stage 3-4 chronic kidney disease (CKD) and resistant hypertension. While central pressures and arterial stiffness showed numerical improvements, kidney function remained stable post-procedure.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Interventional Cardiology
Background:
- Central aortic blood pressures and arterial stiffness are superior cardiovascular risk indicators compared to brachial blood pressures.
- The impact of renal denervation (RDN) on these parameters in Stage 3-4 chronic kidney disease (CKD) patients remains unexamined.
Purpose of the Study:
- To assess RDN's effect on central blood pressures (CBP), brachial blood pressures (office and ambulatory), and arterial stiffness.
- To evaluate changes in glomerular filtration rate (GFR), 24-hour urine protein, and echocardiographic cardiac parameters post-RDN.
Main Methods:
- A single-center, single-arm study involving 25 patients with Stage 3-4 CKD and resistant hypertension.
- Key measurements included CBP, pulse wave velocity, ambulatory BP, office BP, GFR, and 24-hour urine protein, assessed pre- and post-RDN up to 24 months.
- Statistical analysis utilized Friedman's ANOVA and Wilcoxon signed-rank tests with Bonferroni correction.
Main Results:
- Office blood pressures significantly decreased from baseline at 6 and 24 months (P ≤ .001).
- Central blood pressures and pulse wave velocity showed non-significant numerical improvements.
- 24-hour ambulatory blood pressure and estimated GFR remained largely unchanged throughout the 24-month follow-up.
Conclusions:
- RDN led to significant, sustained improvements in office blood pressure in CKD patients with resistant hypertension.
- No significant changes were observed in central pressures, arterial stiffness, or kidney function.
- Further research with larger, controlled trials is warranted to confirm these findings.
Background:
Central aortic blood pressures and arterial stiffness are better indicators of cardiovascular outcomes than brachial blood pressures. However, their response to renal denervation (RDN) in patients with Stage 3 and Stage 4 chronic kidney disease (CKD) has not yet been examined.
Objective:
To evaluate the impact of RDN on central blood pressures (CBP), brachial (office and ambulatory) blood pressures, arterial stiffness, glomerular filtration rate (GFR), 24-hour urine protein, and selective cardiac parameters observed on echocardiograms.
Design:
Single-center, single-arm with pre-/post-RDN follow-up.
Setting:
Patients were recruited from the multidisciplinary CKD clinic, Regina General Hospital, Canada.
Patients:
About 25 consecutive patients with Stage 3 or Stage 4 CKD and resistant hypertension, with no radiological or laboratory evidence of secondary causes of hypertension.
Measurements:
The key measurements were CBP, pulse wave velocity, ambulatory 24-hour blood pressure, office blood pressures on BP Tru, GFR, 24-hour urine protein and sodium, dose and number of blood pressure medication and doses.
Methods:
The primary outcome measure was the change in CBP from baseline to 6 months post-RDN. Secondary outcome measures included changes in CBP, office blood pressure, 24-hour ambulatory pressures, pulse wave velocity, kidney function (eGFR and 24-hour protein excretion), and the change in the number and dose of medications during the 2-year follow-up period. The primary outcome and the secondary outcomes were evaluated using a Friedman's analysis of variance (ANOVA) and Wilcoxon signed-rank test for changes from post RDN procedure. Bonferroni correction was used to adjust P values for multiple testing. A two-sided alpha of .05 was used.
Results:
Median central blood pressures (mm Hg) were 127/75 at baseline versus 118/70 at 6 months and 118/67 at 24 months (P = .13). Median office blood pressures (mm Hg) were 148/76 at baseline versus 135/75 at 6 months and 133/75 at 24 months (P ≤ .001). Median ambulatory 24-hour day (mm Hg) was 148/64 at baseline and 146/68 at 6 months and 152/67 at 24 months (P = .60). Median pulse wave velocity (m/s) at baseline was 13.8 at baseline versus 13.3 m/s at 6 months and 12.3 at 12 months' time (P = .62). Estimated glomerular filtration rate (mL/min/1.73m2) at baseline was 37, at 6 months was 36 and 34 at 24 months (P = .33).
Limitations:
Single-center study, with no sham arm.
Conclusions:
Our study demonstrates that there was a significant improvement in office blood pressures from baseline to 6 months, maintained to 24 months. There was a numerical improvement in central pressures, and pulse wave velocity at 6 and 24 months, with no sustained changes noted in 24-hour blood pressure. Kidney function remained at or near baseline throughout the 24 months of observation.
Trial Registration:
ClinicalTrials.gov (NCT01832233).
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