Background: Previously we reported the benefit of distal over conventional renal denervation (RDN) in patients with resistant hypertension (RHT). Distal treatment applies mainly in segmental branches of the artery beyond the bifurcation and accompanied by repeated bolus injection of contrast directly into the segmental arteries with “tight” filling the vessel. Therefore, such an intensive injection of contrast in intrarenal artery may increase the nephrotoxicity of intervention, especially in diabetic patients. Purpose: The aim of this study was to evaluate a change of renal function after distal denervation in diabetic patients with RHT versus conventional intervention. Methods: Twenty five diabetic patients with true RHT were included in singlearm prospective interventional study (detailed protocol was published on Clinical‐ Trial.gov, number NCT01499810) (mean age 61.6±7.3 years, mean office blood pressure (BP) 171.8±21.9/87.7±17.7mmHg, 8 men), among them 13 undergone distal RDN and 12 ‐ conventional RDN. Office BP measurement, ambulatory 24‐ hour BP, renal Doppler ultrasound and assessment of renal function (eGFR according to MDRD formula and 24‐hour urinary albumin excretion (UAE)) were performed at baseline and 12 months follow up. None of the patients changed the antihypertensive and antidiabetic treatments during follow‐up. Results: There were no any difference in sex, old and BP level between two groups. The 24h mean systolic BP decreased powerfully in the distal treatment group: ‐26.6±20.3, p<0.001, and only slightly ‐ in conventional RDN group: ‐ 8.9±15.3, p=0.07. The difference between two groups was statistically significant, p=0.02. At the same time, 24h mean pulse BP decreased significantly only in the distal treatment group: ‐14.7±11.6 mmHg (p=0.001), whereas change of those in conventional RDN group was not significant (p=0.9). There was not significant change of eGFR from 68.9±18.6 to 63.4±20.7 mL/min/1.73m2, p=0.19 in distal RDN group, without significant changes of those in the conventional RDN group (from 65.5±13.3 to 65.5±12.8 mL/min/1.73m2, p=0.9). Additionally, there was trend toward decrease in UAE in both groups (from 37.3±54.7 to 20.4±22.7 mg/24h, p=0.16 in distal RDN group and from 21.1±11.9 to 14.1±12.7, p=0.15 in conventional RDN group). However, the difference of change of eGFR and UAE between two groups was not significant (‐5.4±12.9 vs. 0.2±12.4 mL/min/1.73m2, p=0.3 for eGFR and ‐16.9/36.6 vs. ‐7.1/12.1 mg/24h, p=0.3 for UAE). There were no significant changes of blood flow in renal arteries according to renal Doppler ultrasound in both groups. Conclusions: This is the first study to demonstrate that distal RDN in diabetic patients with RHT has a significantly greater blood pressure lowering effect then conventional mode of the intervention without significant differences in the changes of glomerular filtration rate and urinary albumin excretion.
CITATION STYLE
Falkovskaya, A., Mordovin, V., Pekarskiy, S., Baev, A., Semke, G., Ripp, T., … Gusakova, A. (2017). 4121Renal function after distal renal denervation and conventional intervention in diabetic patients with resistant hypertension. European Heart Journal, 38(suppl_1). https://doi.org/10.1093/eurheartj/ehx504.4121
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