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Renal denervation has been proven to be beneficial in treating resistant hypertension in patients with normal renal function. There are a significant number of end stage renal disease (ESRD) patients who have resistant hypertension despite being on multiple drugs and the benefits of RDN in such patients have not been reported. Renal denervation has been studied using proprietary catheters but the same procedure can be done by conventional catheters. The use of additional mapping and imaging techniques can help in precise localization of the RF lesions.
We report use of standard 4mm tip 5F RF catheters with conventional RF generators to give RF lesion to renal arteries using rotational angiography and 3D electroanatomical mapping to plan and guide the placement of these lesions in 9 patients with ESRD and uncontrolled hypertension.
There was a significant drop in blood pressure in all the patients 26.8 ± 13.5 mmHg in systolic and 14.8 ± 6.7 mmHg fall in diastolic BP at 1week follow up and 38.0 ± 12.12 mmHg systolic, 19.3 ± 7.21 mmHg fall in diastolic BP at 1 month follow up. The drop in blood pressure was persistent and was 41.8 ± 16.3 mmHg in systolic and 20.4 ± 9.7 mmHg fall in diastolic BP at 6month follow up as compared to baseline. There were no peri-procedural complications.
The use of conventional RF catheters for renal denervation is feasible and effective. Renal denervation in ESRD patients is as effective in controlling hypertension as in patients without renal failure. The use of additional mapping and imaging modalities helps in more precise location of the lesions and may increase the safety of the procedure.