305 TRANSCATHETER RENAL DENERVATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND RESISTANT HYPERTENSION

Abstract

Background: Recently, the transcatheter renal denervation procedure (TRD) has proved effective in lowering blood pressure (BP), in cases of refractory hypertension (RHTN). This study evaluated the safety and efficacy of TRD as well as its impact on glomerular filtration and proteinuria in patients with RHTN and chronic kidney disease (CKD). Methods: 4 patients with CKD (stages 3 and 4) and RHTN underwent bilateral TRD with standard cardiac irrigated catheter ablation. Ambulatory blood pressure monitoring for 24 hours, office BP measurements, estimated glomerular filtration rate (eGFR), plasma creatinine and urinary total protein/ microalbumin were obtained at baseline and 1 month after the procedure. Renal Duplex ultrasound was also performed before the procedure. Measurements of plasma catecholamines, renin and angiotensin were made before the intervention, immediately after and 30 days after the procedure. Results: The means and standard errors of baseline BP was 188.5 ± 8.9 / 104.4 ± 4.3 mmHg; baseline eGFR was 42.4 ± 12.2 ml/min/1.73m2. BP values 7 and 30 days after the procedure were reduced to 126 ± 5.4 / 82.2 ± 2.9 and 128.7 ± 6.1 / 81.8 ± 3.8, respectively (P <0.05 for all comparisons). There was an average reduction of 1.8 antihypertensive drugs (P <0.05) per patient. There were no complications and no significant change in eGFR or in all substances measured. Conclusions: TRD may be performed safely and effectively in patients with RHTN and CKD, using standard irrigated ablation catheter, resulting in reduction in the number of antihypertensive drugs used without impaired renal function.