Kidney Week

Abstract: TH-PO1178

Radiofrequency Renal Denervation in Patients with Severe CKD, Including Patients on Dialysis: Analysis from the Global SYMPLICITY Registry DEFINE

Session Information

• Late-Breaking Science Posters
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Schlaich, Markus P., University of Western Australia, Perth, Western Australia, Australia

Markus P. Schlaich, MD

• Mahfoud, Felix, Universitatsspital Basel, Basel, BS, Switzerland

Felix Mahfoud, MD

• Narkiewicz, Krzysztof, Gdanski Uniwersytet Medyczny, Gdansk, Pomorskie, Poland

Krzysztof Narkiewicz, MD, PhD

• Ruilope, Luis M., Hospital 12 de Octobre, Madrid, Spain

Luis M. Ruilope, MD, PhD

• Sharif, Faisal, University of Galway, Galway, Ireland

Faisal Sharif, PhD

• Ribichini, Flavio Luciano, Universita degli Studi di Verona Scuola di Medicina e Chirurgia, Verona, Veneto, Italy

Flavio Luciano Ribichini, MD

• Böhm, Michael, Universitatsklinikum des Saarlandes, Homburg, Saarland, Germany

Michael Böhm, MD

Background

There is a paucity of data regarding the effect of renal denervation in patients with severe chronic kidney disease (CKD).

Methods

This analysis from the Global SYMPLICITY Registry DEFINE assessed blood pressure (BP) and renal function in patients with uncontrolled hypertension treated with radiofrequency (RF) RDN. BP and eGFR changes from baseline through 12 months were compared across three groups according to baseline eGFR (mL/min/1.73m²): eGFR <45, eGFR 45-59, and eGFR ≥60, adjusted for baseline BP. Furthermore, we assessed these changes among a subset of 36 patients on dialysis.

Results

Baseline office SBP (OSBP) was similar between eGFR subgroups (p=0.28), although ambulatory SBP (ASBP) was higher in those with eGFR<45, p=0.037; Fig 1A). Patients in the <45 eGFR subgroup were significantly older, were more likely to have ischemic heart disease, heart failure, or diabetes. At 12 months, each eGFR subgroup had clinically meaningful SBP drops from baseline (Fig1A). At 12 months, eGFR remained stable in the two lower eGFR subgroups (Fig1B). Estimated GFR declined by 5.7±15.8 ml/min/1.73 m² in the eGFR ≥60 subgroup. Patients on dialysis (72% on hemodialysis, 33% on peritoneal dialysis) had substantial drops in both OSBP and ASBP after RF RDN (Fig1C). Among the dialysis subgroup there were 2 deaths and 2 vascular complications.

Conclusion

Patients with moderate to severe CKD including those requiring dialysis experienced significant OSBP and ASBP reductions from baseline through 12 months after RF RDN. The eGFR of patients with moderate to severe CKD remained stable through 12 months. The data showed that RDN is efficacious and safe for BP reduction in CKD, which needs to be further evaluated.

Funding

• Commercial Support – Medtronic