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Cited by 155Blood Pressure and Hypertension StudiesDialysis and Renal Disease ManagementRenal and Vascular Pathologies

Feasibility of catheter-based renal nerve ablation and effects on sympathetic nerve activity and blood pressure in patients with end-stage renal disease

Schlaich, Markus P., Bart, Bradley, Hering, Dagmara, Walton, Anthony, Marusic, Petra, Mahfoud, Felix, Böhm, Michael, Lambert, Elisabeth A. +8 more·2013·International Journal of Cardiology
DOI 10.1016/j.ijcard.2013.01.218
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Abstract

Background and objectives Sympathetic activation is a hallmark of ESRD and adversely affects cardiovascular prognosis. Efferent sympathetic outflow and afferent neural signalling from the failing native kidneys are key mediators and can be targeted by renal denervation (RDN). Whether this is feasible and effective in ESRD is not known.Design, setting, participants and measurements In an initial safety and proof-of-concept study we attempted to perform RDN in 12 patients with ESRD and uncontrolled blood pressure (BP). Standardized BP measurements were obtained in all patients on dialysis free days at baseline and follow up. Measures of renal noradrenaline spillover and muscle sympathetic nerve activity were available from 5 patients at baseline and from 2 patients at 12 month follow up and beyond.Results Average office BP was 170.8 ± 16.9/89.2 ± 12.1 mmHg despite the use of 3.8 ± 1.4 antihypertensive drugs. All 5 patients in whom muscle sympathetic nerve activity and noradrenaline spillover was assessed at baseline displayed substantially elevated levels. Three out of 12 patients could not undergo RDN due to atrophic renal arteries. Compared to baseline, office systolic BP was significantly reduced at 3, 6, and 12 months after RDN (from 166 ± 16.0 to 148 ± 11, 150 ± 14, and 138 ± 17 mmHg, respectively), whereas no change was evident in the 3 non-treated patients. Sympathetic nerve activity was substantially reduced in 2 patients who underwent repeat assessment.Conclusions RDN is feasible in patients with ESRD and associated with a sustained reduction in systolic office BP. Atrophic renal arteries may pose a problem for application of this technology in some patients with ESRD.

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  • Only two small pilot studies have been conducted, both uncontrolled but successful, in renal hypertension and in end-stage renal disease.

    “To this point only two small pilot studies have been conducted, both uncontrolled but successful, in renal hypertension, and in end-stage renal disease107–108.”

    From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [108]

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Authors
Schlaich, M. P., Bart, B., Hering, D., Walton, A., Marusic, P., Mahfoud, F., Böhm, M., Lambert, E. A., Krum, H., Sobotka, P. A., Schmieder, R. E., Ika-Sari, C., Eikelis, N., Straznicky, N., Lambert, G. W., & Esler, M. D.
Affiliations
  • Baker Heart and Diabetes Institute (AU)
  • University of Minnesota (US)
  • The Alfred Hospital (AU)
  • Universitätsklinikum des Saarlandes (DE)
  • Monash University (AU)
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
ORCID
Venue
International Journal of Cardiology
Publisher
Elsevier BV
Published
2013-10
Volume
168
Issue
3
Pages
2214-2220
ISSN
0167-5273 (ISSN-L)
DOI
10.1016/j.ijcard.2013.01.218
OpenAlex
W2065121034
Cited by
155
References
30
Citations by year
2026: 8 · 2025: 7 · 2024: 4 · 2023: 8 · 2022: 5 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 2 · 2017: 11 · 2016: 21 · 2015: 20 · 2014: 33 · 2013: 21 · 2012: 1
FWCI
21.62
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • International Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Swinburne figshare (Swinburne University of Technology) (submittedVersion)
Funders
  • Australian Government
  • State Government of Victoria
  • National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
Keywords
renal denervation, renal nerve ablation, end-stage renal disease, uncontrolled hypertension, blood pressure reduction, muscle sympathetic nerve activity, noradrenaline spillover, sympathetic nervous system, dialysis, cardiovascular risk
MeSH terms
Blood Pressure, Feasibility Studies, Female, Follow-Up Studies, Humans, Hypertension, Renal, Kidney, Kidney Failure, Chronic, Male, Middle Aged, Sympathectomy, Sympathetic Nervous System, Time Factors, Treatment Outcome, Catheter Ablation

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