Simon Schneider1, Dominik Promny1, Daniel Sinnecker1, Robert A Byrne2, Alexander Müller1, Michael Dommasch1, Agnes Wildenauer3, Georg Schmidt4, Uwe Heemann3, Karl Ludwig Laugwitz4, Marcus Baumann2. 1. I. Medizinische Klinik und Poliklinik, Department of Cardiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 2. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. 3. Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 4. I. Medizinische Klinik und Poliklinik, Department of Cardiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Abstract
BACKGROUND:Sympathetic overactivity is frequently observed following renal transplantation (RTx), and post-transplant hypertension is a major contributing factor to graft failure and cardiovascular morbidity. This process is perpetuated by preservation of sympathetic afferent activity from the native non-functional kidneys, in the absence of efferent feedback to the renal transplant, which would otherwise modulate neurohumoral activity. We investigated the feasibility and efficacy of renal sympathetic denervation (RDN) in renal transplant recipients. METHODS:Patients (n = 18) with post-transplant hypertension were randomized 1:1 to receive RDN or medical treatment alone. The primary efficacy end point was change in office systolic blood pressure (SBP) and mean 24-hambulatory blood pressure monitoring (ABPM) at 6 months. Safety end points were changes in renal function or renovascular complications. RESULTS: After 6 months, patients in the RDN group had a significant reduction in office SBP of 23.3 ± 14.5 mmHg (P = 0.001 for change difference between the groups). In ABPM, nocturnal blood pressure was reduced in the RDN group by -10.38 ± 12.8 mmHg (P = 0.06), whereas no change was measured during the day. In the RDN group, significantly more patients converted from non-dippers to dippers (P = 0.035). There were no adverse safety events in either group. CONCLUSION:RDN is feasible and safe in renal transplant recipients. However, larger sham-controlled studies will be necessary to clarify the potential role of RDN in this population. CLINICAL TRIAL REGISTRATION: NCT01899456.
RCT Entities:
BACKGROUND: Sympathetic overactivity is frequently observed following renal transplantation (RTx), and post-transplant hypertension is a major contributing factor to graft failure and cardiovascular morbidity. This process is perpetuated by preservation of sympathetic afferent activity from the native non-functional kidneys, in the absence of efferent feedback to the renal transplant, which would otherwise modulate neurohumoral activity. We investigated the feasibility and efficacy of renal sympathetic denervation (RDN) in renal transplant recipients. METHODS:Patients (n = 18) with post-transplant hypertension were randomized 1:1 to receive RDN or medical treatment alone. The primary efficacy end point was change in office systolic blood pressure (SBP) and mean 24-h ambulatory blood pressure monitoring (ABPM) at 6 months. Safety end points were changes in renal function or renovascular complications. RESULTS: After 6 months, patients in the RDN group had a significant reduction in office SBP of 23.3 ± 14.5 mmHg (P = 0.001 for change difference between the groups). In ABPM, nocturnal blood pressure was reduced in the RDN group by -10.38 ± 12.8 mmHg (P = 0.06), whereas no change was measured during the day. In the RDN group, significantly more patients converted from non-dippers to dippers (P = 0.035). There were no adverse safety events in either group. CONCLUSION: RDN is feasible and safe in renal transplant recipients. However, larger sham-controlled studies will be necessary to clarify the potential role of RDN in this population. CLINICAL TRIAL REGISTRATION: NCT01899456.
Authors: Ekamol Tantisattamo; Miklos Z Molnar; Bing T Ho; Uttam G Reddy; Donald C Dafoe; Hirohito Ichii; Antoney J Ferrey; Ramy M Hanna; Kamyar Kalantar-Zadeh; Alpesh Amin Journal: Front Med (Lausanne) Date: 2020-06-16
Authors: Neil A Hoye; Luke C Wilson; Gerard T Wilkins; David L Jardine; Tracey L Putt; Ari Samaranayaka; John B W Schollum; Robert J Walker Journal: Kidney Int Rep Date: 2017-05-04