Renal sympathetic nerve ablation for the treatment of difficult-to-control or refractory hypertension in a haemodialysis patient

Daniele, Nicola Di; Francesco, M. De; Violo, Leano; Spinelli, Alessio; Simonetti, Giovanni

doi:10.1093/ndt/gfs044

Cited by 44 publications

(35 citation statements)

References 3 publications

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“…We speculated that PRD could also be used in high-cardiovascular-risk ESRD patients with renal hypertension to reduce the morbidity and mortality of this hypertensive population (8).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, continuous flushing of the catheter with heparinized saline does not result in constant cooling of the wall at the level of the ablation site. Thus, frequent automatic locking of the generator before 120 s may occur, with the need to repeat the ablation at the same point several times until the total time established is reached, increasing the procedural time (mean of 60-90 s more per ablation site) (6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

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Technical aspects of renal denervation in end-stage renal disease patients with challenging anatomy

Spinelli¹,

Ros²,

Morosetti³

et al. 2014

Diagn Interv Radiol

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We describe our preliminary experience with percutaneous renal denervation in end-stage renal disease patients with resistant hypertension and challenging anatomy, in terms of the feasibility, safety, and efficacy of this procedure. Four patients with end-stage renal disease patients with resistant hypertension (mean hemodialysis time, 2.3 years) who had been taking at least four antihypertensive medications underwent percutaneous renal denervation. Renal artery eligibility included the absence of prior renal artery interventions, vessel stenosis <70%, or extended calcifications (more than 30% of the vessel circumference). No cut off values of vessel diameter were used. All patients were successfully treated with no intra-or postprocedural complications, and all showed 24-hour ambulatory blood pressure reduction at the 12-month follow-up. Percutaneous renal denervation is a feasible approach for end-stage renal disease patients with resistant hypertension with encouraging short-term preliminary results in terms of procedural efficacy and safety.

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“…We speculated that PRD could also be used in high-cardiovascular-risk ESRD patients with renal hypertension to reduce the morbidity and mortality of this hypertensive population (8).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Technical aspects of renal denervation in end-stage renal disease patients with challenging anatomy

Spinelli¹,

Ros²,

Morosetti³

et al. 2014

Diagn Interv Radiol

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show abstract

“…With regard to dialysis patients with medication refractory hypertension, 2 individual case reports of RDN have been published so far both resulting in modest BP reduction. 85,86 …”

Section: Implications Of Rdn Beyond Bp Reductionmentioning

confidence: 99%

Renal Denervation

et al. 2014

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Resistant hypertension, defined as failure to reach blood pressure (BP) goals despite treatment with ≥3 antihypertensive agents, one of which is a diuretic, bears a significant risk of cardiovascular complications. Strong evidence exists, implicating the overactivation of the sympathetic nervous system (SNS) in the pathogenesis of resistant hypertension through complex neurohormonal interactions. Renal denervation is a novel attractive option to achieve adequate blockade of the sympathetic system, with subsequent BP reductions in patients with resistant hypertension. Data have shown promising results regarding the efficacy of the procedure, maintaining a favorable safety profile. As such, the paradigm of resistant hypertension has expanded in other conditions involving a hyperadrenergic state such as the metabolic syndrome, heart failure, arrhythmias, sleep apnea, and renal failure. This review focuses on the pathophysiological rationale of modifying SNS tone and the evidence of the benefits of such intervention beyond BP control.

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“…Substantial decreases in office, or sometimes ambulatory, blood pressure have occasionally been reported in treatment-resistant hypertensive patients, who did not comply with the entry criteria of the Symplicity studies [11][12][13] due to previous stenting of the renal arteries [35,36], impossibility to denervate both sides for anatomical reasons [37] or end-stage renal disease needing hemodialysis [38]. Three case reports describe the lack of any blood pressure-lowering effect after unilateral renal denervation [39], and the development of secondary hypertension due to renal artery stenosis 5-6 months after renal denervation [40,41].…”

Section: Case Reportsmentioning

confidence: 99%

Renal denervation in treatment-resistant hypertension: the need for restraint and more and better evidence

Persu

Renkin

Asayama

et al. 2013

Expert Review of Cardiovascular Therapy

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The Symplicity studies suggest that intravascular renal sympathetic nervous denervation improves blood pressure in patients with resistant hypertension, thus potentially opening a market for devices to be used when conventional drug therapy fails to restore blood pressure control. However, the size and durability of the antihypertensive, renal and sympatholytic effects of renal denervation, the long-term safety, improvement of quality of life, the possibility to relax antihypertensive drug treatment, the cost-effectiveness, and long-term hard cardiovascular-renal outcomes still remain to be firmly established. Most ongoing studies are small, industry-driven and purely observational with objectives to test new catheters and source of energy for renal nerve ablation or to search for ancillary benefits and new indications of the technique. The most urgent need, that is adequately powered randomized clinical trials testing renal denervation versus usual medical therapy delivered according to the state-of-the-art are under-represented and seldom funded by industry. The authors make a plea for a coordinated research effort in Europe. With this objective, they established collaboration with leading European experts and started the European Network for Coordinating Research on Renal Denervation. In the meantime, renal denervation should remain the ultima ratio in adherent and truly resistant patients with severe hypertension, confirmed by ambulatory monitoring, in whom secondary hypertension has been excluded and in whom all other efforts to reduce blood pressure have failed.

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Renal sympathetic nerve ablation for the treatment of difficult-to-control or refractory hypertension in a haemodialysis patient

Cited by 44 publications

References 3 publications

Technical aspects of renal denervation in end-stage renal disease patients with challenging anatomy

Technical aspects of renal denervation in end-stage renal disease patients with challenging anatomy

Renal Denervation

Renal denervation in treatment-resistant hypertension: the need for restraint and more and better evidence

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