Abstract
Sympathetic neural activation is markedly increased in end-stage kidney disease (ESKD). Catheter-based renal denervation (RDN) reduces sympathetic over-activity and blood pressure in resistant hypertension. The effect of renal denervation on sympathetic neural activation and left ventricular mass was investigated in patients with ESKD. Nine ESKD (six haemodialysis and three peritoneal dialysis) patients with a dialysis vintage of ≥11 months were treated with RDN (EnligHTN system). Data were obtained on a non-dialysis day; at baseline, one (1M), three (3M) and twelve months (12M) post-RDN. At baseline, sympathetic neural activation measured by muscle sympathetic nervous activity (MSNA) and plasma norepinephrine concentrations were markedly elevated. Left ventricular hypertrophy (LVH) was evident in eight of the nine patients. At 12M post-RDN, blind analysis revealed that MSNA frequency (-12.2 bursts·min-1, 95% CI [-13.6, -10.7]) and LV mass (-27 g·m-2, 95% CI [-47, -8]) were reduced. Mean ambulatory BP (systolic: -24 mmHg, 95% CI [-42, -5] and diastolic: -13 mmHg, 95% CI [-22, -4]) was also reduced at 12M. Office BP was reduced as early as 1M (systolic: -25 mmHg, 95% CI [-45, -5] and diastolic: -13 mmHg, 95% CI [-24, - 1]). Both ambulatory and office BP had clinically significant reductions in at least 50% of patients out to 12M. Catheter-based RDN significantly reduced MSNA and LV mass as well as systemic BP in this group of patients with ESKD.