RELEVANCE OF TARGETING THE DISTAL RENAL ARTERY AND BRANCHES WITH RADIOFREQUENCY RENAL DENERVATION–INSIGHTS FROM A POST-HOC ANALYSIS IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS

Abstract

Objective: We previously reported that renal denervation (RDN) approach aimed at chronic kidney (CKD) disease and hypertension management was efficient in reducing blood pressure (BP) in resistant hypertensive patients with chronic kidney disease (CKD) in the long-term. Taking into account recent data obtained from the SPYRAL HTN-OFF and HTN-ON MED trials, we now performed a post hoc analysis in our resistant hypertensive patients with CKD to evaluate whether our (RDN) approach yielded a close association with the magnitude of the BP response. Design and method: We performed a post hoc analysis of a 24-month follow up evaluation of 30 patients who underwent RDN between 2011 and 2012 using a standard irrigated cardiac ablation catheter radiofrequency based approach. We assessed the association between changes from baseline to 12 and 24-months follow-up in mean ambulatory systolic and diastolic BP and the total number of ablation sites. Furthermore, we explored whether or not distal vs proximal treatment may influence this association. Results: The mean change in ambulatory systolic BP compared to baseline was −19.4 ± 12.7 mmHg (95%CI: −24.1 to −14.6) at 12-month (p < 0.0001) and −21.3 ± 14.1 mmHg (95%CI: −26.9 to −15.7) at 24-month follow-up (p < 0.0001). There was no correlation between ambulatory systolic BP-lowering effect and the total number (17.7 ± 6.0) of renal artery ablation sites neither at 12 (Pearson: r = −0.3 (95%CI: −0.6 to 0.1), p = 0.1542) nor at 24 (Pearson: r = −0.2 (95%CI: −0.5 to 0.2), p = 0.4009) months post-procedure. However, correlations between ambulatory systolic BP-lowering effect and the number of treatments performed in the distal segment and branches were significant at the 12 (Pearson: r = −0.7 (95% CI: −0.8 to −0.4), p < 0.0001) and 24-months follow-up (Pearson: r = −0.8 (95%CI: −0.9 to −0.6), p < 0.0001). Conclusions: Our findings confirm that in a cohort of CKD patients with resistant hypertension RDN resulted in a significant and sustained ambulatory BP reduction. Importantly, only the number of ablations performed in the distal segment and branches of renal arteries correlated strongly with the long-term systolic BP-lowering efficacy. Our post-hoc analysis supports the notion that RDN performed distally and in the branches may yield a more favourable long-term BP response.