Abstract 17557: Does Renal Denervation Stopp Renal Function Decline in Treatment Resistant Hypertension: Results of a Pilot Study
Background: Renal denervation (RDN) emerged as an innovative interventional antihypertensive therapy in patients with treatment resistant hypertension. Since arterial hypertension is a predominant risk factor of renal function decline over time and achieving blood pressure (BP) targets preserves renal function, we analysed whether reducing BP by RDN preserves renal function.
Methods: 15 patients with treatment resistant hypertension (office BP ≥140/90 mmHg, while on at least 3 antihypertensives, confirmed by 24-h ABPM ≥130/80 mmHg) and chronic kidney disease (CKD) stage 3 and 4 (estimated glomerular filtration rate (eGFR) 15-60 ml/min/1.73m2) underwent catheter-based RDN using the Symplicity FlexTM catheter (Medtronic Inc., Palo Alto, CA). The study was registered at www.clinicaltrials.gov (ID: NCT01442883). Renal function was evaluated up to 3 years prior and till 1 year after RDN. The change in eGFR over time was calculated by regression slope individually for each patient. Central hemodynamics were assessed using pulse wave analysis (SphygmoCorTM System, AtCor Medical, Sydney, Australia).
Results: Patients (66 ± 8 years) were treated with 5.8 ± 1.2 antihypertensive drugs on average, and about 3/4 had type-2 diabetes. One year after RDN, brachial office BP was reduced by 26/6 mmHg (systolic: 167 ± 22 versus 141 ± 11 mmHg, p=0.004; diastolic: 78 ± 13 versus 73 ± 9 mmHg, p=0.079), aortic systolic BP by 24 mmHg (150 ± 17 versus 126 ± 11 mmHg, p=0.001), and average systolic 24-h ABPM by 13 mmHg (157 ± 13 versus 144 ± 12 mmHg, p=0.028). Before RDN mean eGFR decline was -5.6 ml/min/1.73m2 per year, and eGFR remained stable or even increased after RDN (baseline: 47.0 ± 11 versus 1 year: 49.2 ± 14 ml/min/1.73m2), with a significant difference between eGFR change before and after RDN (-5.6±4.4 versus +2.2±8.0 ml/min/1.73m2 per year, p=0.021). None of the patients developed a doubling of serum creatinine or required dialysis after RDN at any point of time.
Conclusion: Our pilot study data indicate that interventional treatment of hypertension with RDN decreases BP and, most importantly, slows or even halts the decline of renal function in treatment resistant hypertensive patients with CKD.
- © 2013 by American Heart Association, Inc.