Renal Denervation in Patients With Moderate to Severe Chronic Kidney Disease

Schlaich MP, Mahfoud F, Böhm M, Narkiewicz K, Ruilope L, Williams B, Mancia G, Sharif F, Ribichini F, Lung TH, Shetty S, Schmieder R (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Hypertension American Heart Association

Book Volume: 82

Pages Range: 2252-2261

Journal Issue: 12

DOI: 10.1161/HYPERTENSIONAHA.125.25470

Abstract

BACKGROUND: Uncontrolled hypertension is common in patients with chronic kidney disease (CKD), putting these patients at high risk for adverse cardiovascular events. Radiofrequency renal denervation (RDN) lowers blood pressure (BP) in patients with hypertension. The Global SYMPLICITY Registry DEFINE enrolled over 3500 patients with uncontrolled hypertension worldwide, including patients with moderate-to-severe CKD. METHODS: Patients were categorized by their baseline estimated glomerular filtration rate (estimated glomerular filtration rate [eGFR], mL/min per 1.73 m2): eGFR ≥60 (no-CKD, n=2539), eGFR ≥45 to <60 (stage 3a, n=496), eGFR ≥30 to <45 (stage 3b, n=256). BP changes from baseline through 3 years were compared between groups. One-year data for 74 CKD stage 4 patients were also assessed. Safety events and eGFR were reported at all time points. RESULTS: Average baseline office systolic BP was similar across the 3 comparator groups (range: 162.8±26.4-164.7±24.8 mm Hg). At 3 years, office systolic BP reductions from baseline were -17.2±28.1 mm Hg, -12.1±30.3 mm Hg, and -13.0±27.3 mm Hg in the no-CKD, CKD 3a, and CKD 3b groups, respectively (all P<0.0001). A mild decline in eGFR through 1 year occurred in the no-CKD group but not in any CKD group. Three-year mortality was 4.3%, 7.0%, and 15.2% in no-CKD, CKD 3a, and CKD 3b groups, respectively. Adverse renal events were rare (<1.0%) across all 3 groups. Antihypertensive medication burden remained high in the no-CKD and CKD 3a groups but declined over 3 years in the CKD 3b group (P=0.007). CONCLUSIONS: In patients with uncontrolled hypertension and moderate-to-severe CKD, radiofrequency RDN results in clinically meaningful and durable BP reduction without renal or vascular safety concerns. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01534299.

Authors with CRIS profile

Roland Schmieder Professur für Innere Medizin (Nephrologie)

Involved external institutions

Dobney Hypertension Centre Cardiovascular Research Institute Basel (CRIB) CH Switzerland (CH) Medical University Gdansk / Gdański Uniwersytet Medyczny Hospital Universitario 12 de Octubre University College London (UCL) University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB University of Galway (NUIG) / Ollscoil na Gaillimhe University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) Medtronic

How to cite

APA:

Schlaich, M.P., Mahfoud, F., Böhm, M., Narkiewicz, K., Ruilope, L., Williams, B.,... Schmieder, R. (2025). Renal Denervation in Patients With Moderate to Severe Chronic Kidney Disease. Hypertension, 82(12), 2252-2261. https://doi.org/10.1161/HYPERTENSIONAHA.125.25470

MLA:

Schlaich, Markus P., et al. "Renal Denervation in Patients With Moderate to Severe Chronic Kidney Disease." Hypertension 82.12 (2025): 2252-2261.

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