EFFECTS OF RENAL DENERVATION IN PATIENTS WITH VERSUS WITHOUT CHRONIC KIDNEY DISEASE

Abstract

Objective: Activity of the sympathetic nervous system (SNS) is increased in hypertensive patients with chronic kidney disease (CKD). In this updated version, we tested the hypothesis whether hypertensive patients with CKD enrolled in the Global Symplicity Registry (GSR) showed different responses in blood pressure (BP) reduction in the short- and long-term follow-up. Design and method: The GSR (NCT 01534299) is a prospective, open-label, international, multicentre observational study for assessment of safety and effectiveness of renal denervation (RDN) among real-world patients treated with the Symplicity™ RDN system (Medtronic, Santa Rosa, CA, USA). Inclusion criteria are age >= 18 years and eligibility for RDN. Office and 24-h ambulatory BP were assessed at pre-specified time-points (12, 24 and 36 months). For the current updated analyses, enrolled patients (N = 1980) were stratified based on baseline estimated glomerular filtration rate in <60 vs. >= 60 ml/min/1.73m2 into with (N = 475) and without (N = 1505) CKD groups. Results: Patients with CKD were significantly older (p < 0.0001) and more likely to be female (p = 0.0027) compared to patients without CKD. At baseline office systolic BP was lower (162.4 ± 26 vs. 165.8 ± 24 mmHg, p = 0.0113), whereas there was no difference in baseline 24-h ambulatory systolic BP (153.6 ± 19 vs. 153.7 ± 18 mmHg, p = 0.9162), in patients with, compared to without CKD. In patients with and without CKD, office as well as 24-h ambulatory BP were significantly reduced after RDN compared to baseline values at all time-points (all p < 0.001). There was a greater office systolic BP reduction in favor of patients without compared to with CKD, whereas no difference in 24-h ambulatory systolic BP reduction after RDN, even after adjustment (Table), was observed.Conclusions: After adjustment for baseline data, BP reduction after RDN showed a disparate response pattern in office and 24-h ambulatory BP reductions in patients with CKD. Data needs to be confirmed by a rigorously conducted, prospective, double-blind, sham-controlled study.