Renal Nerve Ablation in Chronic Kidney Disease Patients
Condition: Hypertension; Chronic Kidney Disease
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Observational

Summary: 
      In patients with treatment resistent hypertension renal nerve ablation emerged as an
      effective interventional approach of treating hypertensive disease with a progressively
      increasing fall in blood pressure. Decreased activity of the sympathetic nervous system is
      one of the major underlying pathogenetic mechanism of the fall in blood pressure but the
      precise mechanisms that causes the fall in blood pressure in the short-term and, in
      particular, long-term remains elusive. The objective of the study is to understand the
      pathogenetic mechanisms of renal denervation beyond the reduced activity of the sympathetic
      nervous system. In 100 hypertensive patients most advanced technology will be applied, before
      and repeatedly after renal denervation, throughout the follow-up period of 1 year. Systemic
      activity of the renin angiotensin aldosterone system, renal perfusion (by MRI spin labelling
      technique), local activity of the renin angiotensin system in the kidney (urinary
      angiotensinogen concentrations), sodium excretion and total sodium content (23 Na-MRI
      technique) and vascular remodelling of small (retinal arterioles 50 - 150 µm) and large
      arteries (carotid - femoral pulse wave velocity and augmentation index, both measured over 24
      hours) will be assessed. Identification of the pathogenetic mechanisms involved in the fall
      in blood pressure after renal denervation may help to identify those hypertensive patients
      that profit most from renal nerve ablation in terms of blood pressure reduction.

      The investigators propose the following hypotheses why a progressive decrease in blood
      pressure happens, in addition to the decreased activity of the central nervous system, after
      renal nerve ablation:

      Short term effects:

      A)Preservation of renal function and perfusion B)Reduction of local RAS activity in the
      kidney C)Exaggerated sodium excretion immediately after renal nerve ablation

      Long term effects:

      D)Decrease of total sodium content after 6 and 12 months. E)Improvement of vascular wall
      properties after 6 and 12 months
    

Detailed description: 
      In patients with treatment resistent hypertension renal nerve ablation emerged as an
      effective interventional approach of treating hypertensive disease with a progressively
      increasing fall in blood pressure. Decreased activity of the sympathetic nervous system is
      one of the major underlying pathogenetic mechanism of the fall in blood pressure but the
      precise mechanisms that causes the fall in blood pressure in the short-term and, in
      particular, long-term remains elusive. The objective of the study is to understand the
      pathogenetic mechanisms of renal denervation beyond the reduced activity of the sympathetic
      nervous system. In 100 hypertensive patients most advanced technology will be applied, before
      and repeatedly after renal denervation, throughout the follow-up period of 1 year. Systemic
      activity of the renin angiotensin aldosterone system, renal perfusion (by MRI spin labelling
      technique), local activity of the renin angiotensin system in the kidney (urinary
      angiotensinogen concentrations), sodium excretion and total sodium content (23 Na-MRI
      technique) and vascular remodelling of small (retinal arterioles 50 - 150 µm) and large
      arteries (carotid - femoral pulse wave velocity and augmentation index, both measured over 24
      hours) will be assessed. Identification of the pathogenetic mechanisms involved in the fall
      in blood pressure after renal denervation may help to identify those hypertensive patients
      that profit most from renal nerve ablation in terms of blood pressure reduction.
    

Intervention name(s): Simplicity Catheter
Intervention type(s): Device
Intervention description(s): percutaneous selective renal sympathetic nerve ablation with the use of the Simplicity Catheter system
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        treatment resistant hypertensive adults with chronic kidney disease 3 - 5
      
Keywords: Treatment Resistant