Abstract

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 (p < 0.05). This decrease of 24 h-ABP persisted for 24 months after RDN showed difference systolic blood pressure (p < 0.001) and diastolic blood pressure (p = 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 (p > 0.05). UACR levels were significantly reduced at 3 months and 6 months after RDN (p < 0.001). After RDN, the heart rate showed no significant changes (p > 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.

中文翻译：

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肾神经支配术对慢性肾脏病患者高血压的疗效和安全性的荟萃分析

摘要

背景

肾脏去神经支配术（RDN）是治疗慢性肾脏疾病（CKD）患者高血压的一种新方法，但其疗效尚有争议。这项荟萃分析旨在评估RDN对CKD患者高血压的疗效和安全性。

方法

搜索PubMed，Web of Science，EMBASE和Ovid数据库以查找已发表的相关研究。我们对RDN后的血压，估计的肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR）的变化进行了固定和随机效应的荟萃分析。

结果

荟萃分析包括来自11个单中心，非随机，非对照研究的238位患者。RDN 1个月后，办公室血压和24小时动态血压（24 h-ABP）显着降低（p  <0.05）。RDN显示收缩压（p  <0.001）和舒张压（p  = 0.001）差异后，这种24 h-ABP下降持续了24个月。在亚组分析中，24 h-ABP表现出相似的趋势。在RDN之后的每个分析时间点获得的eGFR测量值与之前获得的测量值无显着差异（p  > 0.05）。RDN后3个月和6个月UACR水平显着降低（p <0.001）。RDN后，心率无明显变化（p  > 0.05），几乎没有遇到重大并发症。

结论

荟萃分析显示，RDN治疗CKD高血压患者可能是有效和安全的。迫切需要精心设计的RDN随机对照试验，以确认RDN的安全性和可重复性，并评估其对临床结果的影响。