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

Abstract

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.

Endovascular Renal Denervation in End-Stage Kidney Disease Patients: Cardiovascular Protection—A Proof-of-Concept Study

“…The small and variable sample size, although larger than in previous case studies, 23 , 24 , 25 , 26 , 27 limited the statistical analysis approach used and led to wide CIs. Care is therefore needed when generalizing the results.…”

“…Five case studies have reported RDN as feasible and efficacious in ESKD, despite the presence of smaller renal artery luminal diameter and atrophic kidneys. 23 , 24 , 25 , 26 , 27 , 28 Schlaich et al. 27 have thus far reported the largest cohort of 9 successful denervations in ESKD.…”

Device-based approaches for renal nerve ablation for hypertension and beyond

“…With respect to safety, only 2 patients developed perioperative femoral pseudo-aneurysms that were resolved without further sequelae. Findings from the pilot trial are supported by an elegant case series involving four patients (age range: 22–65 years) with ESRD and difficult anatomy (renal arteries < 4 mm) (Spinelli et al, 2014 ), which reported a mean reduction in 24-h ambulatory BP of −36/−16 mmHg at 12-months follow-up. With the exception of notches detected on the final angiogram, no other procedure related complications were reported.…”

“…Central sympathetic activity present in ESRD patients is driven principally by afferent renal nerve signaling from the diseased native kidneys (Converse et al, 1992 ). To date, the use of RDN to reduce increased cardiovascular mortality in ESRD patients with renal hypertension has been explored in a limited number of clinical studies (Schlaich et al, 2009b ; Spinelli et al, 2014 ). In a proof-of-concept study of 9 patients with ESRD and hypertension, RDN resulted in sustained reductions in office SBP of −18, −16, and −28 mmHg at 3−, 6−, and 12-months, respectively (Schlaich et al, 2009b ).…”