Improvement of albuminuria after renal denervation

Objectives: The primary objective of this study was the effect of renal denervation (RDN) on elevated urinary albumin-to-creatinine ratio (UACR) in treatment-resistant hypertensive patients. In addition, patients were stratified according their UACR at baseline into micro- (30-300 mg/g, n = 37) and macroalbuminuria (>= 300 mg/g, <2200 mg/g, n= 22). Background: Increased albuminuria indicates cardiovascular and renal damage in hypertension. RDN emerged as an innovative interventional approach to reduce blood pressure (BP) and may thus reduce albumin urinary excretion. Methods: Fifty-nine treatment-resistant hypertensive patients with elevated UACR at baseline underwent catheter-based RDN using the Symplicity Flex (TM) catheter (Medtronic Inc., Santa Rosa, CA). Results: In the whole and pre-specified subgroups both office and 24-h ambulatory BP were significantly reduced 6 months after RDN. In parallel, a significant reduction in UACR occurred in all patients (160 (65-496) versus 89 (29-319) mg/g creatinine, p < 0.001) and in both subgroups (microalbuminuria: 83 (49-153) versus 58 (17-113) mg/g creatinine, p = 0.001; macroalbuminuria: (536 (434-1483) versus 478 (109-1080) mg/g creatinine, p < 0.001). In accordance, the prevalence of micro-and macroalbuminuria decreased significantly. Regression analysis revealed amodest positive relationship between the decrease of UACR and the fall of systolic BP (beta = 0.340, p = 0.039) independent of renal function. Renal function remained unchanged after RDN. Conclusions: In summary, following RDN, the magnitude of albuminuria as well as the prevalence of micro-and macroalbuminuria decreased in treatment-resistant hypertensive patients. Since albuminuria is an independent renal and cardiovascular risk factor, our findings suggest a reduction of renal and cardiovascular risk in these patients. (c) 2014 Elsevier Ireland Ltd. All rights