Central Blood Pressure and Pulse Wave Velocity Changes Post Renal Denervation in Patients With Stages 3 and 4 Chronic Kidney Disease: The Regina RDN Study

Abstract

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).

Effect of combined renal denervation and pulmonary vein isolation in atrial fibrillation recurrence in hypertensive patients: A meta‐analysis

“…There were concerns of possible renal artery stenosis or compromised kidney function especially in patients with underlying CKD after renal denervation. Studies by Hering et al and Prasad et al on patients with CKD stage 3–4 found no significant alterations in kidney function after renal denervation until 12 and 24 months follow‐up, respectively 31,32 . There was no reported decline in eGFR or significant renal issues observed in the included studies in patients who underwent RSDN.…”

Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease: a meta-analysis

“…Of the 35 studies included in the full-text evaluation, seven were excluded because they were case reports, three were excluded because of the study protocol, two were excluded for insufficient data, two were excluded for duplicate patient data, and 10 did not meet the inclusion criteria. Finally, 11 single-center, non-randomized, uncontrolled studies were included in the meta-analysis (Figure 1) [18][19][20][21][22][23][24][25][26][27][28]. These 11 studies included 238 patients and are summarized in Table 1.…”

“…As shown in Table 4, two articles reported eGFR values at 1 month [21,23], four articles reported eGFR values at 3 months and 6 months [18,21,23,27], three articles reported eGFR values at 12 months [20,21,27], and two articles reported eGFR values at 24 months after RDN [21,27]. The heterogeneity among the studies was significant; therefore, the random-effects model was used for the analysis (Table 4).…”

“…Data on UACR levels were reported in four studies [18,21,23,27] (Table 4). UACR levels were significantly reduced at 3 months and 6 months after RDN (all, p < 0.001).…”

Is There Any Role for Device Therapies in Resistant Hypertension? PRO

“…In a nonrandomized renal-denervation intervention in patients with existing CKD, kidney function appeared stable when followed for the next 2 years (17). In the Global SYM-PLICITY Registry, with enrollment currently at about 2600 people who have undergone a radiofrequency ablation in the renal artery, no significant safety signal in terms of renovascular anatomy (i.e., unanticipated renal artery stenosis) or greater-than-expected kidney function decline has been noted.…”