Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease: a meta-analysis.

BACKGROUND

Renal denervation (RDN) is a new treatment for hypertension in patients with chronic kidney disease (CKD), but its efficacy is still debated. This meta-analysis aimed to evaluate the efficacy and safety of RDN for hypertension in patients with CKD.

METHODS

PubMed, Web of Science, EMBASE, and Ovid databases were searched for relevant studies published. We performed both fixed- and random-effects meta-analyses of the changes in blood pressure, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (UACR) after RDN.

RESULTS

The meta-analysis included 238 patients from 11 single-center, non-randomized, uncontrolled studies. Office blood pressure and 24-hour ambulatory blood pressure (24 h-ABP) showed a significant reduction 1 month after RDN ( < 0.05). This decrease of 24 h-ABP persisted for 24 months after RDN showed difference systolic blood pressure ( < 0.001) and diastolic blood pressure ( = 0.001). The 24 h-ABP exhibited a similar trend in the subgroup analysis. eGFR measurements obtained at each time point of analysis after RDN were not significantly different from those obtained before ( > 0.05). UACR levels were significantly reduced at 3 months and 6 months after RDN ( < 0.001). After RDN, the heart rate showed no significant changes ( > 0.05), and few major complications were encountered.

CONCLUSIONS

The meta-analysis showed that RDN may be effective and safe for treating CKD patients with hypertension. Well-designed randomized controlled trials of RDN are urgently needed to confirm the safety and reproducibility of RDN and to assess its impact on clinical outcomes.