Feasibility and safety of renal denervation (RDN) in patients with end-stage renal disease (ESRD) and refractory hypertension (RHT)

Objective To evaluate the feasibility and safety of renal denervation (RDN) in patients with end-stage renal disease (ESRD) and refractory hypertension (RHT).

A retrospective analysis was conducted on the baseline and follow-up data of ESRD patients who underwent RDN at the First Affiliated Hospital of Fujian Medical University between December 2017 and December 2024. Based on the etiology of ESRD, the patients were divided into three groups: diabetic nephropathy group (DN group), chronic glomerulonephritis group (CG group), and hypertensive nephrosclerosis group (HE group). RDN was performed using the NavStar pressure monitoring perfusion monopolar ablation catheter (Abbott, USA). A 3D model was constructed using the ENSITE system, and four-quadrant spiral point-by-point ablation was performed from distal to proximal on the main renal arteries and their branches bilaterally. Each ablation site was treated for 40 seconds at a temperature of 40°C. The ablation power was set at 8W for renal artery branches and 12W for the main branches.

A total of 25 ESRD patients were enrolled, including 10 in the DN group, 8 in the CG group, and 7 in the HE group. All patients underwent regular hemodialysis with controlled dry weight. The number of ablation points was 15.04 ± 2.62 for the main branches and 4.68 ± 1.03 for the branch vessels. Fluoroscopy time was 23.64 ± 6.89 minutes, and contrast agent volume was 28.4 ± 8.5mL. No significant differences were observed among subgroups in terms of impedance, contrast agent volume, or fluoroscopy time before and after ablation. HE group had the least number of ablation points in both main and branch vessels. One case of vascular dissection requiring renal artery stent implantation occurred in the CG group, and one case of pseudoaneurysm occurred in the HE group. The median follow-up duration was 7.90 ± 1.55 months. During follow-up, one patient was lost to follow-up in each the DN and CG groups, and one patient in each the CG and HE groups died due to myocardial infarction. Major adverse cardiovascular events (MACE) occurred in one patient each in the CG and HE groups, both requiring hospitalization for heart failure. Postoperative follow-up was completed in 21 patients. Among them, 15 (71.43%) exhibited a positive response to RDN, including 8 (88.89%) in the DN group, 4 (66.67%) in the CG group, and 3 (50%) in the HE group. Compared with preoperative values, office systolic and diastolic blood pressure, as well as 24-hour ambulatory systolic and diastolic blood pressure, showed significant reductions after RDN.

Renal denervation (RDN) effectively reduced blood pressure in patients with end-stage renal disease (ESRD) and resistant hypertension (RHT). Among the etiological subgroups, patients with diabetic nephropathy may represent the most suitable candidates for RDN within the ESRD population. Competing Interest Statement The authors have declared no competing interest. Clinical Trial ChiCTR-ONC-17012483 Funding Statement The authors acknowledge very helpful discussions with Zhoufei Fang. This research was supported by NSF Grant No. 2023Y9067. /No.2024J0558. /No.2024J01516. /No.2024Y977./No. N2024LH035 (1) Fujian Province science and technology innovation joint fund project?To investigate the effect and mechanism of ATP6AP1L on neuronal injury in paraventricular nucleus of spontaneously hypertensive rats by renal denervation?2023Y9067. (2) Natural Science Foundation of Fujian Province?The optimal time and the protective mechanism of target organ in the intervention of renal nerve in stroke-prone spontaneously hypertensive rats?2024J0558. (3) Natural Science Foundation of Fujian Province?The role and regulation of miR-128 protein mediated proliferation of vascular smooth muscle cells in spontaneously hypertensive rats,2024J01516. (4) Fujian Province science and technology innovation joint fund project?Mechanism of ubiquitination modification of miR-128 protein after renal denervation on proliferation of vascular smooth muscle cells in spontaneously hypertensive rats?2024Y977. (5) Science and Technology Innovation Joint Fund Project of Nanping, Fujian Province. Efficacy and Mechanism Exploration of Pulmonary Vein Isolation Combined with Renal Denervation in the Treatment of Persistent Atrial Fibrillation Complicated with Refractory Hypertension. N2024LH035 Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This is a registered clinical trial (Chinese Clinical Trial Registry identifier: ChiCTR-ONC-17012483 titled “Indication Screening and Technical Optimization of Renal Denervation for Refractory Hypertension.” The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Fujian Medical University (Approval No.: 2017-001-02). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes DATA AVAILABILITY The data that support the findings of this study are available from the corresponding author upon reasonable request.