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Renal denervation preserved renal function in resistant hypertension, CKD

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DALLAS — Pilot study data have shown that in addition to reducing BP, catheter-based renal denervation may slow and even halt the decline of renal function in patients with treatment-resistant hypertension and chronic kidney disease.

The aim of the study was to determine whether reducing BP with renal denervation preserved renal function, since arterial hypertension is a predominant risk factor of renal function decline over time and reaching BP targets has been shown to preserve renal function.

The study, which was presented at AHA 2013, included 15 patients (age, 66 ± 8 years) with treatment resistant hypertension — defined as office BP ≥140/90 mm Hg — while on at least three antihypertensive medications, which was confirmed by 24-hour ambulatory BP monitoring (ABPM) ≥130/80 mmHg, and chronic kidney disease (CKD) stage 3 and 4. Patients underwent catheter-based renal denervation with the Symplicity Flex catheter (Medtronic). Roland E. Schmieder, MD, of the University Hospital of Erlangen in Germany, and fellow researchers assessed renal function up to 3 years before and 1 year after therapy.

 

Roland E. Schmieder

On average, patients were treated with 5.8 ± 1.2 antihypertensive drugs and about 75% had type 2 diabetes.

One-year results indicated that brachial office BP was reduced by 26/6 mm Hg (P for systolic=.004; P for diastolic=.079), aortic systolic BP by 24 mm Hg (P=.001) and mean systolic 24-hour ABPM by 13 mm Hg (P=.028).

Before renal denervation, mean estimated glomerular filtration rate (eGFR) decline was –5.6 mL/min/1.73m² per year. After renal denervation, eGFR remained stable or even increased (baseline, 47.0 ± 11 mL/min/1.73m² vs. 1 year, 49.2 ± 14 mL/min/1.73m²), with a significant difference reported between eGFR change before and after therapy (–5.6 ± 4.4 mL/min/1.73m² vs. 2.2 ± 8.0 mL/min/1.73m² per year; P=.021).

No patients developed a doubling of serum creatinine or required dialysis after renal denervation at any time period, Schmieder reported. – by Brian Ellis

For more information:

Schmieder RE. Abstract #17557. Presented at: the American Heart Association Scientific Sessions; Nov. 16-20, 2013; Dallas.

Disclosure: Schmieder reports receiving research grant support and honoraria from and serving as a consultant/on the advisory board of Medtronic.