肾去神经支配可保留慢性肾脏病合并顽固性高血压患者的肾功能。
Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension.
作者信息
Ott Christian, Mahfoud Felix, Schmid Axel, Toennes Stefan W, Ewen Sebastian, Ditting Tilmann, Veelken Roland, Ukena Christian, Uder Michael, Böhm Michael, Schmieder Roland E
机构信息
aDepartment of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen bKlinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar cDepartment of Radiology, University of Erlangen-Nuremberg, Erlangen dDepartment of Forensic Toxicology, Institute of Legal Medicine, Goethe University, Frankfurt/Main, Germany.
出版信息
J Hypertens. 2015 Jun;33(6):1261-6. doi: 10.1097/HJH.0000000000000556.
OBJECTIVES
Arterial hypertension and increased sympathetic activity are underlying pathogenetic mechanisms of the progressive loss of renal function in patients with chronic kidney disease (CKD). Meta-analyses have shown that impaired renal function is an independent cardiovascular risk factor. We hypothesized that renal denervation (RDN) decreases the decline of renal function in patients with CKD stages 3 and 4 and treatment-resistant hypertension.
METHODS
We performed an observational study of 27 patients with CKD stages 3 and 4, office blood pressure (BP) ≥ 140/90 mmHg, while on at least three antihypertensive drug classes including diuretic, and diagnosis confirmed by 24-h ambulatory BP measurement ≥ 130/80 mmHg. All patients underwent catheter-based RDN using the Symplicity Flex RDN System (Medtronic Inc., Santa Rosa, California, USA). Renal function was evaluated for up to 3 years prior and 1 year after RDN. The change in estimated glomerular filtration rate (eGFR) was calculated by regression slope individually for each patient before and after RDN. The study was registered at http://www.clinicaltrials.gov (ID: NCT01442883).
RESULTS
Mean baseline BP was 156 ± 12/82 ± 13 mmHg, despite treatment with 6.2 ± 1.1 antihypertensive drugs. One year after RDN, office BP was reduced by 20 ± 20 (P < 0.001)/8 ± 14 mmHg (P = 0.005) and average 24-h ambulatory BP by 9 ± 14 (P = 0.009)/4 ± 7 mmHg (P = 0.019). Before RDN, eGFR declined by -4.8 ± 3.8 ml/min per 1.73 m per year, and after RDN eGFR improved by +1.5 ± 10 ml/min per 1.73 m at 12 months (P = 0.009).
CONCLUSIONS
Our observational pilot study in patients with CKD stages 3 and 4 indicates that treatment of hypertension with RDN decreases BP and slows or even halts the decline of renal function.
目的
动脉高血压和交感神经活动增强是慢性肾脏病（CKD）患者肾功能进行性丧失的潜在发病机制。荟萃分析表明，肾功能受损是一个独立的心血管危险因素。我们假设，肾去神经支配（RDN）可减缓3期和4期CKD且伴有难治性高血压患者的肾功能下降。
方法
我们对27例3期和4期CKD患者进行了一项观察性研究，这些患者诊室血压（BP）≥140/90 mmHg，正在使用至少三种抗高血压药物，包括利尿剂，且经24小时动态血压测量确诊血压≥130/80 mmHg。所有患者均使用Symplicity Flex RDN系统（美敦力公司，美国加利福尼亚州圣罗莎）接受基于导管的RDN。在RDN术前3年及术后1年评估肾功能。通过回归斜率分别计算每位患者RDN术前和术后的估计肾小球滤过率（eGFR）变化。该研究已在http://www.clinicaltrials.gov注册（编号：NCT01442883）。
结果
尽管使用了6.2±1.1种抗高血压药物治疗，平均基线血压仍为156±12/82±13 mmHg。RDN术后1年，诊室血压降低了20±20（P<0.001）/8±14 mmHg（P=0.005），24小时平均动态血压降低了9±14（P=0.009）/4±7 mmHg（P=0.019）。RDN术前，eGFR每年下降-4.8±3.8 ml/min/1.73 m²，RDN术后12个月，eGFR改善了+1.5±10 ml/min/1.73 m²（P=0.009）。
结论
我们对3期和4期CKD患者进行的观察性初步研究表明，采用RDN治疗高血压可降低血压，并减缓甚至阻止肾功能下降。
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