Preliminary Data Show Potential of Renal Denervation in Several Settings

San Francisco, CA—Although much of the research is still in early stages, renal denervation (RDN) has the potential to benefit a number of novel indications, including chronic kidney disease, arrhythmias and glucose control.

C. Venkata S. Ram, MD, of Dallas Nephrology Associates in Dallas, TX, said that patients with chronic kidney disease (CKD) suffer from inappropriate activation of the sympathetic nervous system, suggesting that RDN may have an effect. Patients with CKD tend to have significant and difficult-to-treat hypertension, as well as increased arterial stiffness; some small studies have shown that arterial stiffness is lessened after RDN. 

“RDN could be a useful alternative to reduce BP in patients with CKD. And accompanied by an improvement in arterial stiffness, [RDN] could have CV benefits,” Ram said. Reducing the hypertension associated with CKD also could help stave off end-stage renal disease.

The ability of RDN to control hypertension and its electrophysiological effects also make it a reasonable candidate for helping prevent or treat atrial fibrillation (AF), especially after ablation, according to Vivek Y. Reddy, MD, of Mount Sinai Hospital in New York. Although much of the data in this field have been conducted in animal models, there are indications that RDN can reduce inducible AF following ablation, he explained.

Reddy and colleagues have begun a single blind, randomized controlled trial that will test AF ablation alone vs. AF ablation along with RDN in patients with hypertension; the primary endpoint will be AF recurrence. Reddy also described some early work suggesting RDN may have potential in ventricular arrhythmias as well.

Promising effects on glucose control, diabetes

Some of the most impressive early data demonstrating the potential of RDN may lie in the field of glucose control and diabetes; 41.3% of the patients in the Global SYMPLICITY registry undergoing RDN have diabetes. Felix Mahfoud, MD, of the Universitätsklinikum des Saarlandes in Germany, said RDN may improve fasting glucose levels, insulin levels and insulin sensitivity.

In one study published in 2011, 37 patients with resistant hypertension underwent RDN and were compared with 13 control patients. The RDN patients had significant reductions in both systolic and diastolic BP, while control patients did not. Fasting glucose improved significantly in RDN patients (see Figure), as did fasting insulin with a drop of 11.6 mcIU/mL at 3 months (P=.006); the control patients saw essentially no change in fasting insulin.

Notably, patients undergoing RDN saw no progression of diabetic status (from glucose intolerance to diabetes), while three of 13 control patients did see such progression. Seven of the RDN patients (19%), however, had a diabetic status regression where glucose intolerance improved to normal glucose tolerance.

Disclosures:

Ram has served as a consultant for Daiichi-Sankyo/Eli Lilly and Company, Forest and Medtronic CardioVascular.

Reddy has served as a consultant and received grant support from
Biosense Webster, Boston Scientific,
Cibiem, Medtronic CardioVascular and St. Jude Medical; and has equity in Sound Innovations.

Mahfoud has been a consultant/received grant/research support from Boston Scientific, Cordis, Medtronic CardioVascular, Recor, St. Jude Medical and Vessix.