Effects of renal denervation with a standard irrigated cardiac ablation catheter on blood pressure and renal function in patients with chronic kidney disease and resistant hypertension

• Published in: European heart journal 2013-07, Vol.34 (28), p.2114-2121
• Main Authors: Kiuchi, Márcio Galindo, Maia, George Luiz Marques, de Queiroz Carreira, Maria Angela Magalhães, Kiuchi, Tetsuaki, Chen, Shaojie, Andrea, Bruno Rustum, Graciano, Miguel Luis, Lugon, Jocemir Ronaldo
• Format: Article
• Language: English
• Subjects: Albuminuria - diagnosis; Albuminuria - etiology; Analysis of Variance; Antihypertensive Agents - therapeutic use; Blood Pressure - physiology; Catheter Ablation - methods; Chronic Disease; Creatinine - metabolism; Drug Resistance; Female; Glomerular Filtration Rate - physiology; Humans; Hypertension - physiopathology; Hypertension - surgery; Male; Middle Aged; Prospective Studies; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - physiopathology; Sympathectomy - methods; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/eht200

Evaluation of the safety and efficacy of renal denervation with a standard irrigated cardiac ablation catheter (SICAC) in chronic kidney disease (CKD) patients with refractory hypertension. Twenty-four patients were included and treated with a SICAC. Denervation was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n = 16), 3 (n = 4), and 4 (n = 4). Data were obtained at baseline and monthly until 180th day of follow-up. Baseline values of blood pressure (mean ± SD) were 186 ± 19 mmHg/108 ± 13 mmHg in the office, and 151 ± 18 mmHg/92 ± 11 mmHg by 24 h ambulatory blood pressure monitoring (ABPM). Office blood pressure values at 180th day after the procedure were 135 ± 13 mmHg/88 ± 7 mmHg (P < 0.0001, for both comparisons). The mean ABPM decreased to 132 ± 15 mmHg/85 ± 11 mmHg at the 180th day after the procedure (P < 0.0001 for systolic and P = 0.0015 for diastolic). Estimated glomerular filtration (mean ± SD) increased from baseline (64.4 ± 23.9 mL/min/1.73 m(2)) to the 180th day (85.4 ± 34.9 mL/min/1.73 m(2), P < 0.0001) of follow-up. The median urine albumin:creatinine ratio decreased from baseline (48.5, IQR: 35.8-157.2 mg/g) to the 180th day after ablation (ACR = 15.7, IQR: 10.3-34.2 mg/g, P = 0.0017). No major complications were seen. The procedure using SICAC seemed to be feasible, effective, and safe resulting in a better control of BP, a short-term increase in estimated glomerular filtration rate, and reduced albuminuria. Although encouraging, our data are preliminary and need to be validated in the long term.