Effect Of Renal Artery Denervation On Cardiorenal Events In Patients With Chronic Kidney Disease Complicated With Refractory Hypertension At Different Stages

Objective: Renal arterial denervation(RDN)and other device-based therapies for arterial hypertension have become the latest way for patients with refractory hypertension(RHT),especially those who have failed the treatment of multiple antihypertensive drugs.Although previous clinical studies have shown that RDN has antihypertensive efficacy and safety in the treatment of refractory hypertension,the therapeutic effect of RDN in patients with RHT complicated with renal insufficiency(CKD)is still blank.RDN treatment of RHT combined with CKD is an unknown field,so our study will explore the therapeutic effect of RDN on patients with CKD combined with RHT at different periods.Meanwhile,we also explore the selection and optimization of RDN surgery.Methods: Patients with different CKD stages combined with RHT and non-CKD RHT patients who received RDN treatment in the First Affiliated Hospital of Fujian Medical University were followed up from September 2016 to December 2020.The study included their baseline data such as gender,age,medication regimen,preoperative baseline blood pressure,creatinine and e GFR.The subjects are divided into 3 groups according to their CKD staging,Group 1: normal and CKD 1-2(n=14),Group 2: CKD3-4(n=15),Group 3 : CKD stage 5(n=13).Among them,13 patients were treated with operative plan one,which nameed THERMOCOOLSMARTTOUCH navigation star pressure monitoring perfusion monopolar ablation catheter ablation therapy,27 patients were adopted with operative plan two,named GL-6W fixed site ablation catheter ablation therapy,2 patients underwent hybrid ablation.All operations were recorded the method,site,temperature,time,parameters and complications related to the operation.Besidees,the study also record the postoperative blood pressure,antihypertensive drug use and renal function changes.Results:(1)There was no significant difference in baseline data among the three groups of Group 1,Group 2 and Group 3.(2)Compared with the preoperative baseline blood pressure,the follow-up up to 24 months after the operation showed that the postoperative blood pressure of each group decreased to varying degrees,and showed a gentle and stable downward trend.[SBP:Group 1:(155.5±16.23)mm Hg VS(126.4±8.41)mm Hg,Group 2:(170.33±10.36)mm Hg VS(135.63±10.17)mm Hg,Group 3:(173.38±11.48)mm Hg VS(144.11± 10.42)mm Hg;DBP: Group 1:(89.57±14.95)mm Hg VS(78.5±9.19)mm Hg,Group 2:(93.4±12.47)mm Hg VS(84.6±8.35)mm Hg,Group 3:(89.31±11.67)mm Hg VS(85.56±9.5)mm Hg].The blood pressure of other patients who were followed up to 36 and 48 months stabilized and did not rebound.(3)Compared with Group 1,patients in Group 2 had a greater drop in blood pressure after 24 months of follow-up [△SBP:(32.5±15.77)mm Hg VS(52.8±38.53)mm Hg,△DBP:(12.7±11.81)mm Hg VS(16.89)±12.41)mm Hg];Compared with Group 3,the blood pressure of patients in Group 2 decreased after 24 months of follow-up [△SBP:(26.89±10.89)mm Hg VS(52.8±38.53)mm Hg,△DBP:(3.89±11.67)mm Hg VS(16.89±12.41)mm Hg].(4)After 24 months of follow-up,8 cases(80%)in Group 1 reached the standard blood pressure,2 cases were effective(20%),and 0 cases were ineffective.In Group 2,6 cases(66.67%)reached the standard,3 cases were effective(33.33%),0 cases were invalid.In Group 3,0 cases reached standard,9 cases were effective(100%),and 0cases were ineffective.With the extension of follow-up time,treatment compliance and effective rate showed a steady upward trend.(5)Patients after RDN treatment were followed up with their medication regimen and compared with the preoperative baseline medication regimen.At 24 months after surgery,the types of medications in each group were reduced to varying degrees [Group1:(4.78±2.12)VS(2.88±)0.83)species;Group 2:(5.49±1.19)VS(3.25±1.28)species;Group 1:(5.23±1.54)VS(3.33±1.58)species].The intensity of medication has also improved to a certain extent.As time goes by,the intensity of medication has steadily decreased [Group 1:(1.90±0.95)VS(1.18±0.51);Group 2:(2.75±0.83)VS(1.42±0.69);Group 1:(1.90±0.95)VS(1.18±0.51);Group 2:(2.75±0.83)VS(1.42±0.69);Group 1:(1.90±0.95)VS(1.18±0.51);Group 2:(2.75±0.83)VS(1.42±0.69);Group 1:(1.90±0.95)VS(1.18±0.51);Group 2:(2.75±0.83)VS(1.42±0.69);Group 1:(3.31±0.97)VS(1.76±1.00)].(6)The follow-up △SBP of the self-measured blood pressure at home for 6 months after surgery was(27.69±16.15)mm Hg for the patients who used operative plan one during the operation,while the △SBP of the 27 patients who used operative plan two was(16.57±15.49)mm Hg.(7)Two of the subjects who underwent operative plan one had renal artery stenosis and were implanted with a renal artery stent,and one of the subjects on surgical procedure had vascular perforation.One patient who underwent RDN surgery died during the postoperative follow-up.Conclusion: The blood pressure of patients with CKD combined with RHT in different periods has decreased to different degrees after RDN treatment.As time goes by,the downward trend tends to be stable,and show safety.In our study,During the progress of CKD,RDN has a more obvious antihypertensive effect in RHT patients with CKD≤4.