Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension
Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension
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DOI：
10.1097/hjh.0000000000000556
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发表时间：
2015-06-01
影响因子：
4.9
通讯作者：
Schmieder, Roland E.
中科院分区：
文献类型：
--
作者：
Ott, Christian;Mahfoud, Felix;Schmieder, Roland E.
目的：动脉高血压和交感神经活动增加是慢性肾病（CKD）患者肾功能进行性丧失的潜在发病机制。荟萃分析显示，肾功能受损是一个独立的心血管危险因素。我们假设肾去神经支配（RDN）可以减少CKD 3期和4期以及难治性高血压患者的肾功能下降。方法：我们对27例CKD 3期和4期患者进行了一项观察性研究，这些患者的血压(BP) >= 140/90 mmHg，同时服用至少三种降压药物，包括利尿剂，24小时动态血压测量证实诊断>= 130/80 mmHg。所有患者均使用simplicity Flex RDN系统（Medtronic Inc., Santa Rosa, California， USA）进行基于导管的RDN。在RDN前3年和RDN后1年评估肾功能。通过回归斜率分别计算每位患者在RDN前后估计肾小球滤过率（eGFR）的变化。该研究注册于www.clinicaltrials.gov （ID: NCT01442883）。结果：平均基线血压为156 +/- 12/82 +/- 13 mmHg，尽管使用了6.2 +/- 1.1抗高血压药物。RDN后1年，办公室血压降低20 +/- 20 (P < 0.001)/8 +/- 14 mmHg (P = 0.005)，平均24小时动态血压降低9 +/- 14 (P = 0.009)/4 +/- 7mmHg （P = 0.019）。RDN前，eGFR每年每1.73 m(2)下降-4.8 +/- 3.8 ml/min， RDN后，12个月时每1.73 m(2)增加+1.5 +/- 10 ml/min （P = 0.009）。结论：我们对CKD 3期和4期患者的观察性初步研究表明，用RDN治疗高血压可降低血压，减缓甚至停止肾功能的下降。
Objectives: Arterial hypertension and increased sympathetic activity are underlying pathogenetic mechanisms of the progressive loss of renal function in patients with chronic kidney disease (CKD). Meta-analyses have shown that impaired renal function is an independent cardiovascular risk factor. We hypothesized that renal denervation (RDN) decreases the decline of renal function in patients with CKD stages 3 and 4 and treatment-resistant hypertension.Methods: We performed an observational study of 27 patients with CKD stages 3 and 4, office blood pressure (BP) >= 140/90 mmHg, while on at least three antihypertensive drug classes including diuretic, and diagnosis confirmed by 24-h ambulatory BP measurement >= 130/80 mmHg. All patients underwent catheter-based RDN using the Symplicity Flex RDN System (Medtronic Inc., Santa Rosa, California, USA). Renal function was evaluated for up to 3 years prior and 1 year after RDN. The change in estimated glomerular filtration rate (eGFR) was calculated by regression slope individually for each patient before and after RDN. The study was registered at www.clinicaltrials.gov (ID: NCT01442883).Results: Mean baseline BP was 156 +/- 12/82 +/- 13 mmHg, despite treatment with 6.2 +/- 1.1 antihypertensive drugs. One year after RDN, office BP was reduced by 20 +/- 20 (P < 0.001)/8 +/- 14 mmHg (P = 0.005) and average 24-h ambulatory BP by 9 +/- 14 (P = 0.009)/4 +/- 7mmHg (P = 0.019). Before RDN, eGFR declined by -4.8 +/- 3.8 ml/min per 1.73 m(2) per year, and after RDN eGFR improved by +1.5 +/- 10 ml/min per 1.73 m(2) at 12 months (P = 0.009).Conclusions: Our observational pilot study in patients with CKD stages 3 and 4 indicates that treatment of hypertension with RDN decreases BP and slows or even halts the decline of renal function.