Catheter-based renal denervation exacerbates blood pressure fall during hemorrhage

Singh, Reetu R. , Sajeesh, Varsha, Booth, Lindsea C., McArdle, Zoe , May, Clive N., Head, Geoffrey A., Moritz, Karen M., Schlaich, Markus P. and Denton, Kate M. (2017) Catheter-based renal denervation exacerbates blood pressure fall during hemorrhage. Journal of the American College of Cardiology, 69 8: 951-964. doi:10.1016/j.jacc.2016.12.014


Author Singh, Reetu R.
Sajeesh, Varsha
Booth, Lindsea C.
McArdle, Zoe
May, Clive N.
Head, Geoffrey A.
Moritz, Karen M.
Schlaich, Markus P.
Denton, Kate M.
Title Catheter-based renal denervation exacerbates blood pressure fall during hemorrhage
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 1558-3597
0735-1097
Publication date 2017-02-28
Sub-type Article (original research)
DOI 10.1016/j.jacc.2016.12.014
Open Access Status Not yet assessed
Volume 69
Issue 8
Start page 951
End page 964
Total pages 14
Place of publication San Diego, CA, United States
Publisher Elsevier
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
Abstract Background Clinical trials applying catheter-based radiofrequency renal denervation (RDN) demonstrated a favorable safety profile with minimal acute or procedural adverse events. Whether ablation of renal nerves adversely affects compensatory responses to hemodynamic challenge has not been extensively investigated. Objectives The aim of this study was to examine the effect of RDN on mean arterial pressure, renal function, and the reflex response to hemorrhage in sheep with normotension (control) or with hypertensive chronic kidney disease (CKD). Methods Sheep underwent RDN (control-RDN, n = 8; CKD-RDN, n = 7) or sham procedures (control-intact, n = 6; CKD-intact, n = 7). Response to hemorrhage (20% loss of blood volume), including plasma renin activity, was assessed at 2 and 5 months post-procedure. Results RDN caused a complete reversal of hypertension and improved renal function in CKD-RDN sheep (p < 0.0001 for 2 and 5 months vs. pre-RDN). In response to hemorrhage, mean arterial pressure fell in all groups, with the fall being greater in the RDN than the intact group (2-month fall in mean arterial pressure: control-intact, −10 ± 1 mm Hg; control-RDN, −15 ± 1 mm Hg; p < 0.05; CKD-intact, −11 ± 3 mm Hg; CKD-RDN, −19 ± 9 mm Hg; p < 0.001). Hemorrhage increased heart rate and plasma renin activity in intact sheep, but these responses were significantly attenuated in control-RDN and CKD-RDN animals. Responses to hemorrhage were remarkably similar at 2 and 5 months post-RDN, which suggests that nerve function had not returned within this time frame. Conclusions In hypertensive CKD sheep, RDN reduced blood pressure and improved basal renal function but markedly compromised compensatory hemodynamic responses to hemorrhage. Therefore, the capacity to respond to a physiological challenge to body fluid homeostasis may be compromised following RDN.
Formatted abstract
Background: Clinical trials applying catheter-based radiofrequency renal denervation (RDN) demonstrated a favorable safety profile with minimal acute or procedural adverse events. Whether ablation of renal nerves adversely affects compensatory responses to hemodynamic challenge has not been extensively investigated.

Objectives: The aim of this study was to examine the effect of RDN on mean arterial pressure, renal function, and the reflex response to hemorrhage in sheep with normotension (control) or with hypertensive chronic kidney disease (CKD).

Methods: Sheep underwent RDN (control-RDN, n = 8; CKD-RDN, n = 7) or sham procedures (control-intact, n = 6; CKD-intact, n = 7). Response to hemorrhage (20% loss of blood volume), including plasma renin activity, was assessed at 2 and 5 months post-procedure.

Results: RDN caused a complete reversal of hypertension and improved renal function in CKD-RDN sheep (p < 0.0001 for 2 and 5 months vs. pre-RDN). In response to hemorrhage, mean arterial pressure fell in all groups, with the fall being greater in the RDN than the intact group (2-month fall in mean arterial pressure: control-intact, −10 ± 1 mm Hg; control-RDN, −15 ± 1 mm Hg; p < 0.05; CKD-intact, −11 ± 3 mm Hg; CKD-RDN, −19 ± 9 mm Hg; p < 0.001). Hemorrhage increased heart rate and plasma renin activity in intact sheep, but these responses were significantly attenuated in control-RDN and CKD-RDN animals. Responses to hemorrhage were remarkably similar at 2 and 5 months post-RDN, which suggests that nerve function had not returned within this time frame.

Conclusions: In hypertensive CKD sheep, RDN reduced blood pressure and improved basal renal function but markedly compromised compensatory hemodynamic responses to hemorrhage. Therefore, the capacity to respond to a physiological challenge to body fluid homeostasis may be compromised following RDN.
Keyword Chronic kidney disease
Hypertension
Mean arterial pressure
Plasma renin activity
Sheep
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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