Abstract
The efficacy of renal sympathetic denervation in end-stage renal disease patients under hemodialysis Chan Joon Kim, Kiyuk Chang, Daewon Kim, Manwon Park, Jung Sun Cho, Sung-Ho Her Introduction: The end-stage renal disease (ESRD) patients who are under under renal replacement therapy, have often have uncontrolled, resistant hypertension. Renal sympathetic denervation (RDN) with radiofrequency ablation catheter has shown promising results in resistant hypertension. The purpose this pilot study is to assess the efficacy of RDN in resistant hypertension in ESRD patients. Method: Patients who are under renal hemodialysis and inter-dialytic SBP > 160 mmHg despite of three or more antihypertensives were eligible for enrollment. 8 patients were allocated to either medical therapy group or RDN group by randomization. RDN was performed with Symplicity RDN catheter (Medtronic®).The primary outcome was change in SBP change in an inter-dialytic day in 3 months. The secondary outcome was change in DBP in 3 months, left ventricular mass index (LVMI). Results: The baseline SBP/DBP were 172.2 ± 9.5/ 88.7 ± 12.1 mmHg for the intervention group and 164.0 ± 6.9/84.7 ± 13.4 for medical group. Baseline ambulatory SBP was 164.8 ± 4.4 for the intervention group and 162 ± 8.4 mmHg for medical therapy group. The 3 month SBP/DBP were 155.5 ± 12.2/80.2 ± 7.7 for the intervention group and 167.5 ± 10.3/83.6 mmHg for medical therapy group. The mean change in SBP was 18.4 ± 4.5 mmHg for the intervention group and 2.8 mmHg ± 3.8 mmHg for the medical group ( p =0.03). The mean LVMI 194.3 ± 10.4 g/m2 for the intervention group and 187.4 ± 11.5 g/m2 for the medical therapy group. The mean change in LVMI was 41.4 ± 3.5 g/m2 for the intervention group and 1.1 g ± 4.4 g/m2 for the medical group ( p =0.03). Conclusion: This pilot study suggests that RDN may have therapeutic effect in resistant hypertension in ESRD patients and may have a role in regression in left ventricular hypertrophy.
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