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Abstract: SA-PO952

Mayo Clinic Experience With Endovascular Renal Denervation for Kidney Pain

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Singh, Vartika, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Bugazia, Seif, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Gulati, Rajiv, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Deshmukh, Abhishek, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Erickson, Stephen B., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hogan, Marie C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

The objective of this study was to evaluate outcomes following endovascular renal denervation (ERD) for intractable kidney pain performed in patients from 1/2017-5/2022. ERD has been used in few medical centers to manage kidney pain and only reported in small case series.

Methods

Retrospective & prospective analysis of 18 patients (with 23 ERDs). Data included patient demographics, etiology, response to ERD, time to recurrence of pain (visual analog scale) following first &/or second ERD. After renal artery angiogram in the electrophysiology lab under general anesthesia, 8 Fr sheath was placed in the femoral artery & renal artery cannulated using a destination sheath. Using Smarttouch DF(TM) catheters, serial, sequential ablation lesions were delivered in a spiral manner from distal to the ostium of renal arteries (power15-20W seeking impedance drop). Repeat renal angiogram was performed to ensure patency of the renal artery.

Results

Eighteen (13 F; 5M; median 42yo, range 23–71) had 23 RDNs (2 bilateral; 5 ipsilateral redos; median follow-up 33mo). Etiologies were loin pain hematuria (LPHS) (n=5; 28%), nephrolithiasis (n=5;28%), PKD (n=5; 28%), reflux (n=1; 5%), NOS (n=2; 11%). Five cases (28%) had recurrent ipsilateral pain at a median 21 mo(range 6-28 mo) after ERD. Six cases (33%; 2M; 4F) had abrogation of their pain (median follow-up 33 mo). Using the 'Was it Worth It' questionnaire, 9 pts reported ERD was worthwhile. A total of 13 (72%) reported improvement or resolution (n=7) of pain. One who underwent bilateral ERD had abrogation of right kidney pain while pain continued on the left kidney. Procedural complications included post-operative pain (n=8), dissection (n=2), retroperitoneal bleed (n=2), stenosis (n=1), where 1 patient experienced renal artery dissection after a repeat procedure. Five (all females) had no benefit from ERD.

Conclusion

ERD reduced or abrogated pain in 13 (72%) cases but had no impact on pain in 5 cases. LPHS cases had the highest likelihood of success. ERD may be used for palliation of pain within an interdisciplinary chronic pain management & rehabilitation program at specialty centers & only when patients have exhausted other conservative measures.

Funding

  • Private Foundation Support