Changes in albumin-to-creatinine ratio at 12-month follow-up in patients undergoing renal denervation

• Published in: Revista portuguesa de cardiologia 2017-05, Vol.36 (5), p.343-351
• Main Authors: Sousa, Henrique, Branco, Patrícia, de Sousa Almeida, Manuel, de Araújo Gonçalves, Pedro, Gaspar, Augusta, Dores, Hélder, Mesquita, João, Andrade, Maria João, Neuparth, Nuno, Aleixo, Ana, Mendes, Miguel, Barata, José Diogo
• Format: Article
• Language: English
• Subjects: Aged; Albuminuria; Albuminuria - urine; Albuminúria; Blood pressure; Creatinine - urine; Desnervação renal; Female; Follow-Up Studies; Hipertensão arterial resistente; Humans; Hypertension - surgery; Hypertension - urine; Kidney - innervation; Kidney - surgery; Male; Pressão arterial; Renal denervation; Resistant hypertension; Sympathectomy; Time Factors
• ISSN: 0870-2551; 2174-2030
• DOI: 10.1016/j.repc.2016.09.019

Sympathetic renal denervation (RDN) was developed as a treatment for the management of patients with resistant hypertension. This procedure may have a positive impact on hypertension-related target organ damage, particularly renal disease, but the evidence is still limited. To assess the impact of RDN on the albumin-to-creatinine ratio (ACR) at 12-month follow-up. From a single-center prospective registry including 65 patients with resistant hypertension undergoing renal denervation, 31 patients with complete baseline and 12-month follow-up blood pressure (BP) measurements (both office and 24-h ambulatory blood pressure monitoring [ABPM]) and ACR were included in the present study. Mean age was 65±7 years, 52% were female, most (90%) had been diagnosed with hypertension for more than 10 years, 71% had type 2 diabetes and 33% had vascular disease in at least one territory. Mean estimated glomerular filtration rate was 73.6±25.1 ml/min/1.73 m2 and 15 patients (48%) had an ACR >30 mg/g. After 12 months, 22 patients were considered BP responders (73%). ACR decreased significantly from a median of 25.8 mg/g (interquartile range [IQR] 9.0-574.0 mg/g) to 14.8 mg/g (IQR 4.5-61.0 mg/g, p=0.007). When the results were split according to systolic BP responder status on ABPM, we found a significant reduction in responders (from 25.6 mg/g [IQR 8.7-382.8 mg/g] to 15.9 mg/g [IQR 4.4-55.0 mg/g], p=0.009), and a numerical decrease in the non-responder subgroup (from 165.0 mg/g [IQR 8.8-1423.5 mg/g] to 13.6 mg/dl [IQR 5.7-1417.0 mg/g], p=0.345). Besides significant reductions in blood pressure (both office and 24-h ABPM), renal denervation was associated with a significant reduction in ACR, a recognized marker of target organ damage. A desnervação simpática renal (RDN) foi desenvolvida como uma forma de tratamento para os doentes com hipertensão arterial resistente (R-HTN). Este procedimento poderá ter um impacto favorável nas lesões de órgão alvo relacionadas com a hipertensão, nomeadamente a doença renal, no entanto, a evidência disponível ainda é escassa. Avaliar o impacto da RDN no rácio albumina-creatinina (ACR) aos 12 meses de seguimento após RDN. Registo prospetivo de centro único incluindo 65 doentes com R-HTN submetidos a RDN, dos quais 31 doentes com avaliação basal e a um ano completa da pressão arterial (na consulta e na monitorização ambulatória [ABPM]) e da ACR foram incluídos no presente estudo. A idade média foi de 65±7 anos, 52% do sexo feminino. A maioria