Bytyqi Venera, Kannenkeril Dennis, Schmid Axel, Striepe Kristina, Bosch Agnes, Karg Marina V, Schiffer Mario, Uder Michael, Schmieder Roland E
Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Clin Kidney J. 2025 Jun 18;18(7):sfaf184. doi: 10.1093/ckj/sfaf184. eCollection 2025 Jul.
Sympathetic overactivation is associated with numerous pathologies, including arterial hypertension, diabetes, metabolic syndrome and chronic kidney disease (CKD). Renal denervation (RDN) has emerged as an adjacent therapy for the management of hypertension. By modulating sympathetic activity in the whole body, RDN has shown conflicting results regarding insulin secretion and glucose homeostasis. The aim of this study is to analyse the impact of RDN on glycaemic control in patients with CKD.
A total of 155 hypertensive patients with ( = 45) or without CKD ( = 110) were included in this post hoc analysis. All patients underwent radiofrequency-, ultrasound- or alcohol injection-based RDN. Fasting plasma glucose (FPG) and haemoglobin A1c levels were measured at baseline, 3 months and 6 months after RDN in parallel with the office and 24-h ambulatory blood pressure. CKD was defined either by clinical diagnosis, an estimated glomerular filtration rate (eGFR) of 15-59 ml/min/1.73 m and/or A2/A3 albuminuria in hypertensive patients, repeatedly confirmed, or several of these criteria.
In the total study cohort, FPG decreased by 5.1 ± 29.1 mg/dl ( = .032) and by 7.9 ± 32.7 mg/dl ( = .003) at 3 and 6 months after RDN, respectively. The change in FPG levels was related to the change in 24-h systolic BP ( = 0.286, = .008) 3 months after RDN. Among patients with CKD, FPG levels decreased by 13.5 ± 43.5 mg/dl at 3 months ( = .043) and by 17.1 ± 45.2 mg/dl at 6 months ( = .015) following RDN. These reductions were greater compared with the non-CKD group ( = .021 and = .024, respectively). After excluding patients on oral antidiabetic or insulin therapy, patients with CKD (but not those without CKD) exhibited a reduction in FPG levels of 6.7 ± 15.3 mg/dl ( = .043) at 6 months post-RDN. No significant changes were observed in eGFR in either group.
We observed that FPG levels improved to a greater extent in hypertensive patients with CKD after RDN. Thus RDN may have a broader therapeutic impact beyond blood pressure reduction in CKD patients.
交感神经过度激活与多种疾病相关，包括动脉高血压、糖尿病、代谢综合征和慢性肾脏病（CKD）。肾去神经支配术（RDN）已成为一种用于治疗高血压的辅助疗法。通过调节全身交感神经活动，RDN在胰岛素分泌和葡萄糖稳态方面显示出相互矛盾的结果。本研究的目的是分析RDN对CKD患者血糖控制的影响。
本事后分析纳入了总共155例高血压患者，其中45例患有CKD，110例未患CKD。所有患者均接受了基于射频、超声或酒精注射的RDN。在RDN后的基线、3个月和6个月测量空腹血糖（FPG）和糖化血红蛋白水平，并同时测量诊室血压和24小时动态血压。CKD的定义为临床诊断、估计肾小球滤过率（eGFR）为15 - 59 ml/min/1.73 m²和/或高血压患者中的A2/A3级蛋白尿，经反复确认，或符合其中几项标准。
在整个研究队列中，RDN后3个月和6个月时，FPG分别下降了5.1±29.1 mg/dl（P = 0.032）和7.9±32.7 mg/dl（P = 0.003）。RDN后3个月，FPG水平的变化与24小时收缩压的变化相关（r = 0.286，P = 0.008）。在患有CKD的患者中，RDN后3个月FPG水平下降了13.5±43.5 mg/dl（P = 0.043），6个月时下降了17.1±45.2 mg/dl（P = 0.015）。与非CKD组相比，这些降幅更大（分别为P = 0.021和P = 0.024）。在排除接受口服降糖药或胰岛素治疗的患者后，患有CKD的患者（而非未患CKD的患者）在RDN后6个月时FPG水平下降了6.7±15.3 mg/dl（P = 0.043）。两组的eGFR均未观察到显著变化。
我们观察到，RDN后患有CKD的高血压患者的FPG水平改善程度更大。因此，RDN可能对CKD患者除降低血压外还有更广泛的治疗作用。
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