Effects of renal denervation on blood pressure in hypertensive patients with end-stage renal disease: a single centre experience

Abstract

BackgroundSympathetic nerve activity is a hallmark of hypertension in end-stage renal disease (ESRD). An initial proof-of-concept study implies that renal denervation (RDN) is feasible and safe in RDN, but overall data are limited.MethodsIn this single-centre prospective pilot study six patients with ESRD and treatment resistant hypertension were consecutively included. Ambulatory blood pressure (ABP) was measured before and 6 months after RDN (Symplictiy Flex™, Medtronic Inc., Santa Rosa, CA). Moreover, haemodialysis parameters which may affect BP reduction were monitored closely.ResultsIn all patients bilateral RDN was successful done, without documentation of peri- or postprocedural complications. There was a significant reduction in 24-h ABP by 20\u2009±\u200917/15\u2009±\u200912\xa0mmHg 6 months after RDN (systolic: 163\u2009±\u200916 versus 143\u2009±\u20099\xa0mmHg, p\u2009=\u20090.043; diastolic: 96\u2009±\u20099 versus 81\u2009±\u200915\xa0mmHg, p\u2009=\u20090.043), with similar results for day-, and nighttime values, respectively. Antihypertensive medication was kept stable as well as there was no change in haemodialysis parameters during follow-up. In addition, ultrafiltration/week (1.4\u2009±\u20091.4 versus 2.2\u2009±\u20091.4\xa0l, p\u2009=\u20090.08) as well as hematocrit (measured at baseline and 6 months after RDN) (33.7\u2009±\u20094.3 versus 33.1\u2009±\u20093.9%, p\u2009=\u20090.715) revealed no change in volume status.ConclusionOur single-centre pilot study not only supports current data on renal safety of RDN even in small arteries of patients with ESRD, but also enhances the knowledge towards an effective ABP reduction in this type of hypertensive patients.