[BP.02.05] FEASIBILITY AND EFFICACY OF RENAL DENERVATION THERAPY IN HEMODIALYSIS PATIENTS WITH RESISTANT HYPERTENSION. (September 2017)

• Record Type: Journal Article
• Authors: Scalise, F.; Sorropago, G.; Auguadro, C.; Ballabeni, C.; Sorropago, A.; Maccario, F.; Mancia, G.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523475.48232.25
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Nephrectomy has been considered for patients with malignant hypertension on dialysis to remove the pressor effects reflexly induced by afferent fibers originating in the renal structure and still active in nonfunctioning kidneys. Because the morbidity and mortality associated with the surgical procedures has limited its adoption, endovascular procedures that might denervate the native nonfunctioning kidney much less invasively has been proposed as an alternative therapeutic strategy. Design and method: we enrolled 5 consecutive dialised patients affected by resistant hypertension (RH, 4 men, 1 women, mean age 50 years). The average duration of dialysis was of 5, 4 years and the average number of antihypertensive drugs for each patient was 3.5. The renal arteries average diameter was 3.96 mm. The cohort underwent bilateral percutaneous trans-catheter renal denervation (RDT) with the EnligHTN System (St. Jude Medical, St Paul, MN, USA). Measurements included intra-arterial Systolic blood pressure (SBP), diastolic (D) BP, mean (M) BP and heart rate (HR). Results: The small basket device of the EnligHTN was used in all patients. RDT was performed without complications, with an average number of ablations of 33, 8. SBP was reduced by the procedure from 162, 7 to 130, 4 mmHg (p-value 0.02) with also a reduction of DBP (from 97, 6 to 83, 6 mmHg, p-value 0.04) and MBP (from 119, 3 to 99, 2 mmHg, p-value 0.03) and no significant HR changes (from 78 to 72 bpm, p-value 0.74). Conclusions: the bilateral RDT procedure in dialised patients with RH was feasible without complications and produced an acute statistically significant decrease in BP.. Diseased kidneys might be the source of a persistently elevated activity of afferent signals to the central sympathetic nervous system, the interruption of which may favour BP reduction. This may be obtain by renal denervation with no need of surgical kidney removal.