Cited by 46Blood Pressure and Hypertension StudiesRenin-Angiotensin System StudiesRenal and Vascular Pathologies

Catheter-Based Renal Denervation Exacerbates Blood Pressure Fall During Hemorrhage

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Singh, Reetu R., Sajeesh, Varsha, Booth, Lindsea C., McArdle, Zoe, May, Clive N., Head, Geoffrey A., Moritz, Karen M., Schlaich, Markus P. +1 more·2017·Journal of the American College of Cardiology

Abstract

Background Clinical trials applying catheter-based radiofrequency renal denervation (RDN) demonstrated a favorable safety profile with minimal acute or procedural adverse events. Whether ablation of renal nerves adversely affects compensatory responses to hemodynamic challenge has not been extensively investigated.Objectives The aim of this study was to examine the effect of RDN on mean arterial pressure, renal function, and the reflex response to hemorrhage in sheep with normotension (control) or with hypertensive chronic kidney disease (CKD).Methods Sheep underwent RDN (control-RDN, n = 8; CKD-RDN, n = 7) or sham procedures (control-intact, n = 6; CKD-intact, n = 7). Response to hemorrhage (20% loss of blood volume), including plasma renin activity, was assessed at 2 and 5 months post-procedure.Results RDN caused a complete reversal of hypertension and improved renal function in CKD-RDN sheep (p < 0.0001 for 2 and 5 months vs. pre-RDN). In response to hemorrhage, mean arterial pressure fell in all groups, with the fall being greater in the RDN than the intact group (2-month fall in mean arterial pressure: control-intact, -10 ± 1 mm Hg; control-RDN, -15 ± 1 mm Hg; p < 0.05; CKD-intact, -11 ± 3 mm Hg; CKD-RDN, -19 ± 9 mm Hg; p < 0.001). Hemorrhage increased heart rate and plasma renin activity in intact sheep, but these responses were significantly attenuated in control-RDN and CKD-RDN animals. Responses to hemorrhage were remarkably similar at 2 and 5 months post-RDN, which suggests that nerve function had not returned within this time frame.Conclusions In hypertensive CKD sheep, RDN reduced blood pressure and improved basal renal function but markedly compromised compensatory hemodynamic responses to hemorrhage. Therefore, the capacity to respond to a physiological challenge to body fluid homeostasis may be compromised following RDN.

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Crossref · 10.1016/j.jacc.2016.12.014

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  • Preclinical studies in sheep and rat models show that renal denervation improves renal function and reduces blood pressure in chronic kidney disease, with effects beyond blood pressure reduction.

    “However, the beneficial effects of RDN on CKD are not limited to its antihypertensive effects, with studies showing direct improvement in renal function following ablation of the renal nerves.”

    From Renal nerves in physiology, pathophysiology and interoception (2025) · cites this paper as [111]

    The Renal Function results (page not supplied) report that denervation lowered blood pressure and increased GFR and renal blood flow at five months in sheep with hypertensive CKD. The paper does not establish that the renal improvement was independent of blood-pressure reduction, and it does not report a comparable CKD finding in rats. (LLM, conf=0.84)

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Authors
Singh, R. R., Sajeesh, V., Booth, L. C., McArdle, Z., May, C. N., Head, G. A., Moritz, K. M., Schlaich, M. P., & Denton, K. M.
Affiliations
  • Monash University (AU)
  • The University of Melbourne (AU)
  • Baker Heart and Diabetes Institute (AU)
  • The University of Queensland (AU)
Corresponding author
Singh, Reetu R.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2017-02
Volume
69
Issue
8
Pages
951-964
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2591421489
Cited by
46
References
43
Citations by year
2025: 2 · 2024: 3 · 2023: 7 · 2022: 3 · 2021: 7 · 2020: 9 · 2019: 9 · 2018: 3 · 2017: 3
FWCI
5.14
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Monash University Research Portal (Monash University) (submittedVersion, other-oa)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
Funders
Servier
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
Keywords
renal denervation, radiofrequency ablation, hemorrhage, hypotension, plasma renin activity, renal function, blood pressure regulation, fluid homeostasis, sheep model
MeSH terms
Animals, Disease Models, Animal, Hemorrhage, Hypertension, Renal Artery, Sheep, Sympathectomy, Catheter Ablation, Renal Insufficiency, Chronic

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