Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension
Abstract
OBJECTIVES: Arterial hypertension and increased sympathetic activity are underlying pathogenetic mechanisms of the progressive loss of renal function in patients with chronic kidney disease (CKD). Meta-analyses have shown that impaired renal function is an independent cardiovascular risk factor. We hypothesized that renal denervation (RDN) decreases the decline of renal function in patients with CKD stages 3 and 4 and treatment-resistant hypertension. METHODS: We performed an observational study of 27 patients with CKD stages 3 and 4, office blood pressure (BP) ≥ 140/90 mmHg, while on at least three antihypertensive drug classes including diuretic, and diagnosis confirmed by 24-h ambulatory BP measurement ≥ 130/80 mmHg. All patients underwent catheter-based RDN using the Symplicity Flex RDN System (Medtronic Inc., Santa Rosa, California, USA). Renal function was evaluated for up to 3 years prior and 1 year after RDN. The change in estimated glomerular filtration rate (eGFR) was calculated by regression slope individually for each patient before and after RDN. The study was registered at http://www.clinicaltrials.gov (ID: NCT01442883). RESULTS: Mean baseline BP was 156 ± 12/82 ± 13 mmHg, despite treatment with 6.2 ± 1.1 antihypertensive drugs. One year after RDN, office BP was reduced by 20 ± 20 (P < 0.001)/8 ± 14 mmHg (P = 0.005) and average 24-h ambulatory BP by 9 ± 14 (P = 0.009)/4 ± 7 mmHg (P = 0.019). Before RDN, eGFR declined by -4.8 ± 3.8 ml/min per 1.73 m per year, and after RDN eGFR improved by +1.5 ± 10 ml/min per 1.73 m at 12 months (P = 0.009). CONCLUSIONS: Our observational pilot study in patients with CKD stages 3 and 4 indicates that treatment of hypertension with RDN decreases BP and slows or even halts the decline of renal function.
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Beneficial effects of renal denervation have been reported in patients with resistant hypertension and chronic kidney disease.
“Moreover, beneficial effects of renal denervation, which targets sympathetic drive, have been reported in patients with resistant hypertension and CKD206,207.”
From The gut microbiota and the brain–gut–kidney axis in hypertension and chronic kidney disease (2018) · cites this paper as [207]
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- Authors
- Ott, C., Mahfoud, F., Schmid, A., Toennes, S. W., Ewen, S., Ditting, T., Veelken, R., Ukena, C., Uder, M., Böhm, M., & Schmieder, R. E.
- Affiliations
- Goethe University Frankfurt (DE)
- Universitätsklinikum des Saarlandes (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Corresponding author
- Schmieder, Roland E.
- ORCID
- Venue
- Journal of Hypertension
- Published
- 2015-06
- Volume
- 33
- Issue
- 6
- Pages
- 1261-1266
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2088323626
- Cited by
- 129
- References
- 34
- Citations by year
- 2026: 12 · 2025: 6 · 2024: 7 · 2023: 13 · 2022: 13 · 2021: 13 · 2020: 11 · 2019: 8 · 2018: 7 · 2017: 17 · 2016: 11 · 2015: 11
- FWCI
- 11.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- European Renal Association-European Dialysis and Transplant Association
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Keywords
- renal denervation, chronic kidney disease, resistant hypertension, renal function, estimated glomerular filtration rate, blood pressure reduction, sympathetic nervous system, catheter ablation, ambulatory blood pressure, estimated glomerular filtration rate decline
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, California, Cardiovascular Diseases, Diuretics, Female, Glomerular Filtration Rate, Humans, Hypertension, Kidney, Male, Middle Aged, Pilot Projects, Risk Factors, Sympathectomy, Sympatholytics, Treatment Outcome, Renal Insufficiency, Chronic
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