Radiofrequency Renal Denervation Demonstrates Sustained Blood Pressure Reduction in Advanced Chronic Kidney Disease

Recent research has highlighted the potential benefits of radiofrequency renal denervation (RDN) for individuals living with moderate to severe chronic kidney disease (CKD) who experience uncontrolled hypertension. The findings, published in the journal Hypertension, suggest that this minimally invasive intervention can result in a significant and lasting decrease in blood pressure (BP), even among those with advanced stages of kidney impairment.

The study enrolled a diverse group of patients with persistent high blood pressure, categorizing them according to their estimated glomerular filtration rate (eGFR), a key indicator of kidney function. Participants were grouped into three categories: those without CKD (eGFR >=60 mL/min/1.73m²), those with stage 3a CKD (eGFR >=45 to <60 mL/min/1.73m²), and those with stage 3b CKD (eGFR >=30 to <45 mL/min/1.73m²). All participants underwent radiofrequency RDN, and their blood pressure and kidney function were monitored over an extended period.

At the outset, average systolic blood pressure was comparable across all groups. After three years of follow-up, patients showed notable reductions in office systolic BP: those without CKD experienced an average decrease of 17.2 mmHg, stage 3a patients saw a decrease of 12.1 mmHg, and those with stage 3b CKD recorded a 13.0 mmHg reduction. These improvements were achieved without significant worsening of kidney function in the moderate and advanced CKD groups, while a mild decline in eGFR was observed in the group without CKD.

When evaluating safety outcomes, the incidence of adverse renal events remained low in all categories, with rates below 1%. Mortality rates over three years were 4.3% for those without CKD, 7.0% for stage 3a CKD, and 15.2% for stage 3b CKD, reflecting the increasing health risks typically associated with advancing kidney disease. Notably, the use of antihypertensive medications remained high in most groups, but a reduction in medication burden was observed among stage 3b CKD patients following RDN, suggesting that the procedure may help decrease dependence on multiple drugs in the most affected individuals.

Radiofrequency renal denervation works by targeting overactive nerves in the renal arteries, which play a role in the regulation of blood pressure. This technique has been under investigation for its potential to aid patients whose hypertension proves resistant to traditional pharmacological therapies, particularly those with underlying renal impairment.

The study's results indicate that RDN could be a promising and safe option for managing high blood pressure in patients with moderate-to-severe CKD, especially when standard treatments fail to provide adequate control. The findings also underscore the importance of considering innovative interventional approaches in populations at high risk of cardiovascular complications due to persistent hypertension and impaired kidney function.

It is important to note that the research was supported by a medical technology company, and several investigators disclosed connections to the pharmaceutical and medical device sectors. Despite these disclosures, the trial's methodology and peer-reviewed publication provide credibility to the reported outcomes. Further studies may be warranted to assess the long-term benefits and optimal patient selection for radiofrequency RDN in the context of chronic kidney disease.

Overall, this study adds to the growing body of evidence supporting the use of radiofrequency renal denervation as a viable strategy for blood pressure management in patients with advanced CKD, potentially improving their long-term health outcomes while maintaining a favorable safety profile.