Renal Nerve Ablation for Hypertensive Patients with Chronic Kidney Disease
Papademetriou V., Doumas M., Anyfanti P., Faselis C., Kokkinos P. and Tsioufis C.
Affiliation: VA Medical Center, 50 Irving Street, NW, Washington, DC 20422.
Keywords: Renal nerve ablation, hypertension, chronic kidney disease, resistant hypertension, renal sympathetic denervation,
end stage renal disease, mild renal insufficiency, sympathetic nervous system.
Among current epidemics, chronic kidney disease (CKD) is accompanied with high morbidity and mortality
rates inherently associated with the thriving comorbidities of hypertension and cardiovascular disease. In this mutually
reinforcing triad, adequate control of high blood pressure emerges as extremely important for decreasing patients’ complication
rates and prolonging life expectancy. However, hypertension control in this particular group of patients is often
proven an arduous task, presenting high rates of resistance. Sympathetic nervous system (SNS) overactivity is implicated
not only in the pathophysiological basis of difficult-to-treat hypertension, but also in the development and progression of
renal disease, thus rendering SNS a prime therapeutic target in CKD. As renal nerve ablation (RNA) is finding its place
among other invasive procedures in the cardiovascular arena, the potential therapeutic impact of this innovative treatment
modality is gradually expanding from resistant hypertension to other high blood pressure-related clinical conditions like
CKD. Encouraging results of clinical trials testing efficacy and safety of renal nerve ablation in resistant hypertensives
provide the opportunity to apply the procedure in other subgroups of hypertensive patients. Available data regarding renal
function of study participants suggest the safe implementation of RNA in patients with renal disease, but both unexplored
benefits as well as potential hazards should be taken into account and critically evaluated. While renal denervation has
been tested in selected cases of patients with renal disease, the results of large, multicenter trials evaluating the effects of
this procedure on large cohorts of patients with CKD are eagerly anticipated.
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