Vascular and Renal Hemodynamic Changes after Renal Denervation

Ott, Christian; Janka, Rolf; Schmid, Axel; Titze, Stephanie; Ditting, Tilmann; Sobotka, Paul; Veelken, Roland; Uder, Michael; Schmieder, Roland E.

doi:10.2215/cjn.08500812

Cited by 52 publications

(33 citation statements)

References 40 publications

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“…Beyond the reduction in peripheral SBP and mean BP, BAT resulted in a significant reduction of aortic SBP. Although an improvement of these parameters has been also been reported after renal denervation [17,42,43], BAT seems to independently exert beneficial effects on central hemodynamics [44].…”

Section: Discussionmentioning

confidence: 96%

Baroreflex activation therapy in patients with prior renal denervation

Wallbach

Halbach

Reuter

et al. 2016

Journal of Hypertension

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Section: Discussionmentioning

confidence: 96%

Baroreflex activation therapy in patients with prior renal denervation

Wallbach

Halbach

Reuter

et al. 2016

Journal of Hypertension

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“…A small cohort study reported an increase in renal artery mean flow 6 months after RDN, as assessed by 3‐dimensional magnetic resonance angiography . In addition, renal vascular resistance has been shown to decrease 3 to 6 months after RDN in patients with resistant hypertension, with no significant increase in renal perfusion detectable on MRI or improvement in renal oxygenation, as determined by blood oxygen level–dependent MRI . However, in a small cohort study of 27 patients with stage 3 or 4 chronic kidney disease, the annual decrease in eGFR was slightly smaller after than before RDN, and this effect was accompanied by a significant decrease in office BP .…”

Section: Discussionmentioning

confidence: 98%

Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial

Courand

Pereira

Giudice

et al. 2017

JAHA

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BackgroundThe DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped‐care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months.Methods and ResultsThis post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline‐adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was −10.1 mm Hg (P=0.0462) in the lowest tertile and −2.5 mm Hg (P=0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m2) but decreased in the control group (−8.0 mL/min per 1.73 m2, P=0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups (P=0.2640).ConclusionsRDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777.

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“…Studies by Hering et al, 16 Ott et al 17 and Zhang et al 18 have demonstrated the safety and potentially beneficial outcomes in patients with stage 3-4 chronic kidney disease and resistant HTN. Similarly, a study by Ott et al has shown that renal perfusion and renal vascular resistance was unaltered post-procedure; 19 however, to our knowledge, this is the first study utilizing phase-contrast velocity mapping to determine renal effects of the procedure alongside eGFR, the widely accepted parameter indicative of renal function.…”

mentioning

confidence: 76%

“…Consistent with previous reports demonstrating decreased renal vascular resistance, this study shows an improvement in total volume of blood to the kidney per cardiac cycle. 19 This could be especially important in patients demonstrating end organ damage as a consequence of consistently increased blood pressures.…”

mentioning

confidence: 99%

Renal sympathetic denervation increases renal blood volume per cardiac cycle: a serial magnetic resonance imaging study in resistant hypertension

Delacroix¹,

Chokka²,

Nelson³

et al. 2017

IJNRD

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Aim: Preclinical studies have demonstrated improvements in renal blood flow after renal sympathetic denervation (RSDN); however, such effects are yet to be confirmed in patients with resistant hypertension. Herein, we assessed the effects of RSDN on renal artery blood flow and diameter at multiple time points post-RSDN. Methods and results: Patients (n=11) with systolic blood pressures ≥160 mmHg despite taking three or more antihypertensive medications at maximum tolerated dose were recruited into this single-center, prospective, non-blinded study. Magnetic resonance imaging indices included renal blood flow and renal artery diameters at baseline, 1 month and 6 months. In addition to significant decreases in blood pressures (p<0.0001), total volume of blood flow per cardiac cycle increased by 20% from 6.9±2 mL at baseline to 8.4±2 mL (p=0.003) at 1 month and to 8.0±2 mL (p=0.04) 6 months post-procedure, with no changes in the renal blood flow. There was a significant decrease in renal artery diameters from 7±2 mm at baseline to 6±1 mm (p=0.03) at 1 month post-procedure. This decrease was associated with increases in maximum velocity of blood flow from 73±20 cm/s at baseline to 78±19 cm/s at 1 month post-procedure. Notably, both parameters reverted to 7±2 mm and 72±18 cm/s, respectively, 6 months after procedure. Conclusion: RSDN improves renal physiology as evidenced by significant improvements in total volume of blood flow per cardiac cycle. Additionally, for the first time, we identified a transient decrease in renal artery diameters immediately after procedure potentially caused by edema and inflammation that reverted to baseline values 6 months post-procedure.

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Vascular and Renal Hemodynamic Changes after Renal Denervation

Cited by 52 publications

References 40 publications

Baroreflex activation therapy in patients with prior renal denervation

Baroreflex activation therapy in patients with prior renal denervation

Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial

Renal sympathetic denervation increases renal blood volume per cardiac cycle: a serial magnetic resonance imaging study in resistant hypertension

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