Abstract
Background and objectives Sympathetic activation is a hallmark of ESRD and adversely affects cardiovascular prognosis. Efferent sympathetic outflow and afferent neural signalling from the failing native kidneys are key mediators and can be targeted by renal denervation (RDN). Whether this is feasible and effective in ESRD is not known. Design, setting, participants and measurements In an initial safety and proof-of-concept study we attempted to perform RDN in 12 patients with ESRD and uncontrolled blood pressure (BP). Standardized BP measurements were obtained in all patients on dialysis free days at baseline and follow up. Measures of renal noradrenaline spillover and muscle sympathetic nerve activity were available from 5 patients at baseline and from 2 patients at 12 month follow up and beyond. Results Average office BP was 170.8 ± 16.9/89.2 ± 12.1 mm Hg despite the use of 3.8 ± 1.4 antihypertensive drugs. All 5 patients in whom muscle sympathetic nerve activity and noradrenaline spillover was assessed at baseline displayed substantially elevated levels. Three out of 12 patients could not undergo RDN due to atrophic renal arteries. Compared to baseline, office systolic BP was significantly reduced at 3, 6, and 12 months after RDN (from 166 ± 16.0 to 148 ± 11, 150 ± 14, and138 ± 17 mm Hg, respectively), whereas no change was evident in the 3 non-treated patients. Sympathetic nerve activity was substantially reduced in 2 patients who underwent repeat assessment. Conclusions RDN is feasible in patients with ESRD and associated with a sustained reduction in systolic office BP. Atrophic renal arteries may pose a problem for application of this technology in some patients with ESRD.
Original language | English (US) |
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Pages (from-to) | 2214-2220 |
Number of pages | 7 |
Journal | International Journal of Cardiology |
Volume | 168 |
Issue number | 3 |
DOIs | |
State | Published - Oct 3 2013 |
Bibliographical note
Funding Information:This study was funded by ARDIAN Inc. and in part by grants from the National Health and Research Council of Australia (NHMRC) and the Victorian Government's Operational Infrastructure Support Program . Dres Schlaich, Esler, E Lambert, and G Lambert are supported by career fellowships from the NHMRC . Dr Dagmara Hering is currently supported by Research Fellowship from the Foundation for Polish Science KOLUMB/2010-1 . Dr. Mahfoud is supported by the Deutsche Hochdruckliga .
Keywords
- End-stage renal disease
- Hypertension
- Renal denervation
- Sympathetic