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

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