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Kidney Week

Abstract: FR-PO244

Effects of Renal Denervation in Patients with Versus Without CKD: Results from the Global SYMPLICITY Registry with Follow-Up Data of 3 Years

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Schmieder, Roland E., University Hospital Erlangen, Erlangen, Germany
  • Mahfoud, Felix, University of the Saarland, Homburg, Germany
  • Mancia, Giuseppe, University of Milan-Bicocca, Milan, Italy
  • Narkiewicz, Krzysztof, Medical University of Gdansk, Gdansk, Poland
  • Ruilope, Luis M., National Instituto of Health, Spain, Madrid, Spain
  • Schlaich, Markus P., The University of Western Australia , CRAWLEY , Western Australia, Australia
  • Williams, Bryan, University College London, London, United Kingdom
  • Böhm, Michael, Saarland University Medical Center, Homburg, Germany
  • Ott, Christian, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
Background

Activity of the sympathetic nervous system (SNS) is increased in hypertensive patients with chronic kidney disease (CKD). We tested the hypothesis that hypertensive patients with CKD enrolled in the Global Symplicity Registry (GSR) show different patterns in blood pressure (BP) outcomes in the short- and long-term follow-up.

Methods

The GSR (NCT 01534299) is a prospective, open-label, international, multicentre observational study for assessment of safety and effectiveness of renal denervation (RDN) among real-world patients treated with the Symplicity™ RDN system (Medtronic, Santa Rosa, CA, USA). Inclusion criteria are age ≥18 years and eligibility for RDN. 24-h ambulatory BP was assessed at pre-specified time-points (6, 12, 24 and 36 months). For the current analyses, enrolled patients (N=1600) were stratified based on baseline estimated glomerular filtration rate in <60 vs. ≥60ml/min/1.73m2 into with (N=383) and without (N=1217) CKD groups.

Results

Patients with CKD were significantly older (p<0.0001) and were treated with more antihypertensive medications (p<0.0001) compared to patients without CKD. 24-h ambulatory diastolic (but not systolic) BP was lower in patients with compared to without CKD (152.9±19/81.3±13 vs. 153.2±18/87.2±14 mmHg, p=0.6380/<0.0001), resulting in an increased pulse pressure. In patients with and without CKD, 24-h ambulatory BP was reduced after RDN compared to baseline values at all time-points (all p<0.01). There was no difference in 24-h ambulatory systolic BP reduction after RDN in favor of patients with compared to without CKD, even after adjustment (Table).

Conclusion

Hypertensive patients with CKD did not show a greater short-term or long-term decrease in 24-hour ambulatory BP.

Changes in ambulatory BP (mmHg)
 CKD6 mo12 mo24 mo36 mo
numberwith/without(n=163/545)(n=146/499)(n=100/337)(n=77/248)
delta systolicwith-4.7±19-4.8±19-5.5±21-9.5±19
delta systolicwithout-7.4±17-7.6±19-8.3±19-8.1±20
p-value* 0.0600.2540.1540.488
 

*adjusted for baseline 24-h ambulatory BP, age and gender