PS-C36-8: BLOOD PRESSURE REDUCTION AFTER RENAL DENERVATION IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: THE ERLANGER EXPERIENCE

Abstract

Background: Hypertension is associated with major cardiovascular and renal adverse events and the 24h-ambulatory blood pressure (BP) is superior than the office BP in predicting these complications. Overactivitiy of the sympathetic nervous system is linked with elevation of systemic BP and is also present in patients with chronic kidney disease (CKD). The aim of this study was to compare the BP lowering effects of renal denervation (RDN) in patients with and without CKD. Methods: Radiofrequency or ultrasound device based renal denervation was performed in 47 patients with and 127 without CKD in our center. Office and 24h-ambulatory BP were assessed after 3, 6 and 12 months by validated devices. CKD was defined by clinical diagnosis or according to the estimated glomerular filtration rate (eGFR: 15–60 ml/min/1.73m2; CKD-EPI formula). Results: Until today, 174 patients with a mean age of 59.0 ± 10 were followed up for at least 12 months. At baseline mean eGFR was 55.8 ± 21 ml/min/1.73m2 in patients with CKD and 87.3 ± 13 ml/min/1.73m2 in patients without CKD. There was no significant eGFR decline in either of the groups during follow up. In patients with CKD eGFR was after 12 months 54.4 ± 23 ml/min/1.73m2 (p = 0.699 vs baseline). Office and 24h-systolic and -diastolic BP were significantly reduced from baseline in patients with or without CKD at all time points after RDN (all p < 0.01). There was no significant difference in the reduction of 24 h, day- and nighttime ambulatory BP between the 2 groups at any time point (see table below). With exception of rare local adverse events (e.g. haematoma at the puncture site), we had no safety signals, especially in our patients with CKD, e.g. there was no dissection, embolism or periprocedural cardiovascular complications. Conclusion: In our single center registry, we observed a similar BP reduction in 24 h, day- and nighttime ambulatory BP as well as in office BP in patients with and without CKD at any time point up to 12 months. There was no safety signal related to RDN. In particular, we did not observe a significant eGFR decline in both CKD positive or negative patients. We conclude that RDN is an effective and safe treatment option for patients with hypertension and chronic kidney disease.