Renal Artery Denervation for Resistant Hypertension, Including Patients with Chronic Kidney Disease: A Long-term Follow-up

Introduction: Resistant hypertension is common in chronic kidney disease (CKD) patients. Hyperactivity of the sympathetic nervous system plays an important role in the development and progression of hypertension. Catheter-based renal artery denervation (RDN) is an evolving technique with promising results regarding the control of hypertension; however, little evidence exists on the effects of the procedure in CKD.

Methods: 39 patients with resistant hypertension, who underwent RDN in Poriya hospital, were followed up for two years. We will discuss acute and long-term effects of RDN on blood pressure, estimated glomerular filtration rate (eGFR) and number of antihypertensive medications, including a subgroup of 18 patients with CKD.

Results: For blood pressure measurements, 36 patients were followed up at six months, 28 at one year, and 28 at two years. The mean changes in systolic blood pressure compared to baseline were -13.9 ± 28.7 (P<0.01), -15.7 ± 27.2 (P<0.01) and -14.4 ± 30.3 (P<0.01) [mm Hg] respectively. For eGFR measurements, 29 patients were followed up at six months, 26 at one year, and 27 at two years. The mean changes in eGFR compared to baseline were -4.76 ± 16.14 (P=0.06), -10.8 ± 15.47 (P<0.01) and - 14.26 ± 17 (P<0.01) [ 2 ml/min/1.73m ] respectively, with CKD patients significantly more affected after two years. There was no significant reduction in the number of antihypertensive medications at the follow-up time points.

Conclusions: Renal denervation was found to be effective in both non CKD and CKD patients in reducing systolic blood pressure in the short and the long term. However, there was a negative effect on renal function in both non CKD and CKD patients, with the latter being more affected at the long term.