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The feasibility, efficacy, and safety of RDN procedure using CO2 angiography through radial artery in severe chronic kidney disease patients

Hypertension Research volume 47, pages 760–766 (2024)Cite this article

A Comment to this article was published on 11 March 2024

Abstract

The recent evidence regarding the effectiveness of renal denervation (RDN) in blood pressure control is becoming increasingly substantial. However, many studies have excluded populations with severely impaired kidney function, even though these individuals have a higher prevalence of hypertension compared to the general population, and controlling their blood pressure is more challenging. The effectiveness and safety of RDN in patients with severe chronic kidney disease (CKD) lack strong evidence support. Concerns about worsening kidney function still exist, particularly in patients with CKD stage 5. We conducted an observational study involving 10 patients who were using at least 3 different antihypertensive medications and had an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 but had not undergone dialysis. For these patients, we performed RDN via the radial artery approach, with the assistance of carbon dioxide (CO2) angiography. Utilizing this approach, the systolic 24-hour ambulatory blood pressure monitoring did not exhibit a significant decrease at 3 months; however, a significant reduction was observed at 6 months after RDN. We also minimized contrast agent usage, observed no kidney function decline 3 months post-RDN, and experienced no vascular-related complications. Using the radial artery approach and CO2 angiography assistance for RDN may be an effective and safe blood pressure control method for patients with severe kidney impairment.

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References

  1. Horowitz B, Miskulin D, Zager P. Epidemiology of hypertension in CKD. Adv Chronic Kidney Dis. 2015;22:88–95.

    Article  PubMed  Google Scholar 

  2. Teo BW, Chan GC, Leo CCH, Tay JC, Chia Y-C, Siddique S, et al. Hypertension and chronic kidney disease in Asian populations. J Clin Hypertens. 2021;23:475–80.

    Article  Google Scholar 

  3. Tedla FM, Brar A, Browne R, Brown C. Hypertension in chronic kidney disease: navigating the evidence. Int J Hypertens. 2011;2011:132405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. An J, Kurella Tamura M, Odden MC, Ni L, Thomas I-C, Montez-Rath ME, et al. Prevalence of apparent treatment-resistant hypertension in chronic kidney disease in two large US Health Care Systems. Clin J Am Soc Nephrol. 2022;17:1457–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Burnier M, Damianaki A. Hypertension as cardiovascular risk factor in chronic kidney disease. Circ Res. 2023;132:1050–63.

    Article  CAS  PubMed  Google Scholar 

  6. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: core curriculum 2019. Am J Kidney Dis. 2019;74:120–31.

    Article  PubMed  Google Scholar 

  7. Salem MM. Pathophysiology of hypertension in renal failure. Semin Nephrol. 2002;22:17–26.

    Article  PubMed  Google Scholar 

  8. Paton JFR, Raizada MK. Neurogenic hypertension. Exp Physiol. 2010;95:569–71.

    Article  PubMed  Google Scholar 

  9. Grassi G, Bertoli S, Seravalle G. Sympathetic nervous system: role in hypertension and in chronic kidney disease. Curr Opin Nephrol Hypertens. 2012;21:46–51.

    Article  CAS  PubMed  Google Scholar 

  10. Guber K, Kirtane AJ. Renal sympathetic denervation for hypertension. Kidney Int Rep. 2022;7:2129–40.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bhatt DL, Vaduganathan M, Kandzari DE, Leon MB, Rocha-Singh K, Townsend RR, et al. Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial. Lancet 2022;400:1405–16.

    Article  PubMed  Google Scholar 

  12. Mahfoud F, Mancia G, Schmieder RE, Ruilope L, Narkiewicz K, Schlaich M, et al. Cardiovascular risk reduction after renal denervation according to time in therapeutic systolic blood pressure range. J Am Coll Cardiol. 2022;80:1871–80.

    Article  CAS  PubMed  Google Scholar 

  13. Campese VM, Kogosov E. Renal afferent denervation prevents hypertension in rats with chronic renal failure. Hypertension 1995;25:878–82.

    Article  CAS  PubMed  Google Scholar 

  14. Nozawa T, Igawa A, Fujii N, Kato B, Yoshida N, Asanoi H, et al. Effects of long-term renal sympathetic denervation on heart failure after myocardial infarction in rats. Heart Vessels. 2002;16:51–6.

    Article  PubMed  Google Scholar 

  15. Hawkins IF. Carbon dioxide digital subtraction arteriography. AJR Am J Roentgenol. 1982;139:19–24.

    Article  CAS  PubMed  Google Scholar 

  16. Sharafuddin MJ, Marjan AE. Current status of carbon dioxide angiography. J Vasc Surg. 2017;66:618–37.

    Article  PubMed  Google Scholar 

  17. Alkhawam H, Popp M, Nasir A, Forsberg M, Mani K. Bilateral renal arteries stenting using carbon dioxide angiography in combination with a minimal iodinated contrast angiography in patient with refractory hypertension and kidney disease. J Am Coll Cardiol. 2020;75:3199.

    Article  Google Scholar 

  18. Xia M, Liu T, Chen D, Huang Y. Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease: a meta-analysis. Int J Hyperth. 2021;38:732–42.

    Article  CAS  Google Scholar 

  19. Liu S, Bian R, Qian Y, Liao H, Gao X, Zhang Y, et al. Catheter-based renal denervation in Chinese patients with chronic kidney disease and uncontrolled hypertension. J Clin Hypertens. 2023;25:71–7.

    Article  Google Scholar 

  20. Marin F, Fezzi S, Gambaro A, Ederle F, Castaldi G, Widmann M, et al. Insights on safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with chronic kidney disease: first Italian real-world experience. J Nephrol. 2021;34:1445–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ott C, Mahfoud F, Mancia G, Narkiewicz K, Ruilope LM, Fahy M, et al. Renal denervation in patients with versus without chronic kidney disease: results from the Global SYMPLICITY Registry with follow-up data of 3 years. Nephrol Dial Transpl. 2022;37:304–10.

    Article  Google Scholar 

  22. Pugh D, Gallacher PJ, Dhaun N. Management of hypertension in chronic kidney disease. Drugs 2019;79:365–79.

    Article  PubMed  PubMed Central  Google Scholar 

  23. de Beus E, de Jager R, Joles JA, Grassi G, Blankestijn PJ. Sympathetic activation secondary to chronic kidney disease: therapeutic target for renal denervation? J Hypertens. 2014;32:1751–61.

    Article  PubMed  Google Scholar 

  24. DiBona GF. Neural control of the kidney: functionally specific renal sympathetic nerve fibers. Am J Physiol Regul Integr Comp Physiol. 2000;279:R1517–24.

    Article  CAS  PubMed  Google Scholar 

  25. Grassi G, Seravalle G, Brambilla G, Trabattoni D, Cuspidi C, Corso R, et al. Blood pressure responses to renal denervation precede and are independent of the sympathetic and baroreflex effects. Hypertension 2015;65:1209–16.

    Article  CAS  PubMed  Google Scholar 

  26. Kandzari DE, Böhm M, Mahfoud F, Townsend RR, Weber MA, Pocock S, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet 2018;391:2346–55.

    Article  PubMed  Google Scholar 

  27. Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet 2017;390:2160–70.

    Article  PubMed  Google Scholar 

  28. Torii S, Mori H, Jinnouchi H, Sakamoto A, Finn A, Virmani R. Renal denervation with ultrasound therapy (paradise device) is an effective therapy for systemic hypertension. J Thorac Dis. 2018;10:S3060–3.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Heradien MJ, Augustyn J, Saaiman A, Brink PA. First reported cases: renal denervation with second-generation multi-electrode catheter via brachial and radial access. Cardiovasc J Afr. 2016;27:53–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Daemen J, Van Mieghem N. First-in-man radial access renal denervation with the ReCor RadianceTM catheter. EuroIntervention. 2015;10:1209–12.

    Article  PubMed  Google Scholar 

  31. Honton B, Pathak A, Sauguet A, Fajadet J. First report of transradial renal denervation with the dedicated radiofrequency IberisTM catheter. EuroIntervention. 2014;9:1385–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

We express our gratitude to the medical team who assisted with the RDN procedure. The icons in “Graphical Abstract” were made by Freepik, Smashicons, and Those Icons from www.flaticon.com. We appreciate the assistance of these authors.

Funding

The funding source for this study is an intramural project from National Taiwan University Hospital.

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Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Hao-Yun Lo, Jen-Kuang Lee & Yen-Hung Lin

  2. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan

    Hao-Yun Lo

  3. National Taiwan University College of Medicine, Taipei, Taiwan

    Jen-Kuang Lee & Yen-Hung Lin

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  1. Hao-Yun Lo
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Correspondence to Jen-Kuang Lee.

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Lo, HY., Lee, JK. & Lin, YH. The feasibility, efficacy, and safety of RDN procedure using CO2 angiography through radial artery in severe chronic kidney disease patients. Hypertens Res 47, 760–766 (2024). https://doi.org/10.1038/s41440-023-01540-3

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