Venera Bytyqi, Dennis Kannenkeril, Axel Schmid, Kristina Striepe, Agnes Bosch, Marina V Karg, Mario Schiffer, Michael Uder, Roland E Schmieder
{"title":"肾去神经支配对合并和不合并慢性肾病的高血压患者糖代谢的影响。","authors":"Venera Bytyqi, Dennis Kannenkeril, Axel Schmid, Kristina Striepe, Agnes Bosch, Marina V Karg, Mario Schiffer, Michael Uder, Roland E Schmieder","doi":"10.1093/ckj/sfaf184","DOIUrl":null,"url":null,"abstract":"<p><strong>Backgroun: </strong>Sympathetic overactivation is associated with numerous pathologies, including arterial hypertension, diabetes, metabolic syndrome and chronic kidney disease (CKD). Renal denervation (RDN) has emerged as an adjacent therapy for the management of hypertension. By modulating sympathetic activity in the whole body, RDN has shown conflicting results regarding insulin secretion and glucose homeostasis. The aim of this study is to analyse the impact of RDN on glycaemic control in patients with CKD.</p><p><strong>Methods: </strong>A total of 155 hypertensive patients with (<i>n</i> = 45) or without CKD (<i>n</i> = 110) were included in this post hoc analysis. All patients underwent radiofrequency-, ultrasound- or alcohol injection-based RDN. Fasting plasma glucose (FPG) and haemoglobin A1c levels were measured at baseline, 3 months and 6 months after RDN in parallel with the office and 24-h ambulatory blood pressure. CKD was defined either by clinical diagnosis, an estimated glomerular filtration rate (eGFR) of 15-59 ml/min/1.73 m<sup>2</sup> and/or A2/A3 albuminuria in hypertensive patients, repeatedly confirmed, or several of these criteria.</p><p><strong>Results: </strong>In the total study cohort, FPG decreased by 5.1 ± 29.1 mg/dl (<i>P</i> = .032) and by 7.9 ± 32.7 mg/dl (<i>P</i> = .003) at 3 and 6 months after RDN, respectively. The change in FPG levels was related to the change in 24-h systolic BP (<i>r</i> = 0.286, <i>P</i> = .008) 3 months after RDN. Among patients with CKD, FPG levels decreased by 13.5 ± 43.5 mg/dl at 3 months (<i>P</i> = .043) and by 17.1 ± 45.2 mg/dl at 6 months (<i>P</i> = .015) following RDN. These reductions were greater compared with the non-CKD group (<i>P</i> = .021 and <i>P</i> = .024, respectively). After excluding patients on oral antidiabetic or insulin therapy, patients with CKD (but not those without CKD) exhibited a reduction in FPG levels of 6.7 ± 15.3 mg/dl (<i>P</i> = .043) at 6 months post-RDN. No significant changes were observed in eGFR in either group.</p><p><strong>Conclusion: </strong>We observed that FPG levels improved to a greater extent in hypertensive patients with CKD after RDN. Thus RDN may have a broader therapeutic impact beyond blood pressure reduction in CKD patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf184"},"PeriodicalIF":3.9000,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231565/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of renal denervation on glucose metabolism in hypertensive patients with and without chronic kidney disease.\",\"authors\":\"Venera Bytyqi, Dennis Kannenkeril, Axel Schmid, Kristina Striepe, Agnes Bosch, Marina V Karg, Mario Schiffer, Michael Uder, Roland E Schmieder\",\"doi\":\"10.1093/ckj/sfaf184\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Backgroun: </strong>Sympathetic overactivation is associated with numerous pathologies, including arterial hypertension, diabetes, metabolic syndrome and chronic kidney disease (CKD). Renal denervation (RDN) has emerged as an adjacent therapy for the management of hypertension. By modulating sympathetic activity in the whole body, RDN has shown conflicting results regarding insulin secretion and glucose homeostasis. The aim of this study is to analyse the impact of RDN on glycaemic control in patients with CKD.</p><p><strong>Methods: </strong>A total of 155 hypertensive patients with (<i>n</i> = 45) or without CKD (<i>n</i> = 110) were included in this post hoc analysis. All patients underwent radiofrequency-, ultrasound- or alcohol injection-based RDN. Fasting plasma glucose (FPG) and haemoglobin A1c levels were measured at baseline, 3 months and 6 months after RDN in parallel with the office and 24-h ambulatory blood pressure. CKD was defined either by clinical diagnosis, an estimated glomerular filtration rate (eGFR) of 15-59 ml/min/1.73 m<sup>2</sup> and/or A2/A3 albuminuria in hypertensive patients, repeatedly confirmed, or several of these criteria.</p><p><strong>Results: </strong>In the total study cohort, FPG decreased by 5.1 ± 29.1 mg/dl (<i>P</i> = .032) and by 7.9 ± 32.7 mg/dl (<i>P</i> = .003) at 3 and 6 months after RDN, respectively. The change in FPG levels was related to the change in 24-h systolic BP (<i>r</i> = 0.286, <i>P</i> = .008) 3 months after RDN. Among patients with CKD, FPG levels decreased by 13.5 ± 43.5 mg/dl at 3 months (<i>P</i> = .043) and by 17.1 ± 45.2 mg/dl at 6 months (<i>P</i> = .015) following RDN. These reductions were greater compared with the non-CKD group (<i>P</i> = .021 and <i>P</i> = .024, respectively). After excluding patients on oral antidiabetic or insulin therapy, patients with CKD (but not those without CKD) exhibited a reduction in FPG levels of 6.7 ± 15.3 mg/dl (<i>P</i> = .043) at 6 months post-RDN. No significant changes were observed in eGFR in either group.</p><p><strong>Conclusion: </strong>We observed that FPG levels improved to a greater extent in hypertensive patients with CKD after RDN. 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Effect of renal denervation on glucose metabolism in hypertensive patients with and without chronic kidney disease.
Backgroun: Sympathetic overactivation is associated with numerous pathologies, including arterial hypertension, diabetes, metabolic syndrome and chronic kidney disease (CKD). Renal denervation (RDN) has emerged as an adjacent therapy for the management of hypertension. By modulating sympathetic activity in the whole body, RDN has shown conflicting results regarding insulin secretion and glucose homeostasis. The aim of this study is to analyse the impact of RDN on glycaemic control in patients with CKD.
Methods: A total of 155 hypertensive patients with (n = 45) or without CKD (n = 110) were included in this post hoc analysis. All patients underwent radiofrequency-, ultrasound- or alcohol injection-based RDN. Fasting plasma glucose (FPG) and haemoglobin A1c levels were measured at baseline, 3 months and 6 months after RDN in parallel with the office and 24-h ambulatory blood pressure. CKD was defined either by clinical diagnosis, an estimated glomerular filtration rate (eGFR) of 15-59 ml/min/1.73 m2 and/or A2/A3 albuminuria in hypertensive patients, repeatedly confirmed, or several of these criteria.
Results: In the total study cohort, FPG decreased by 5.1 ± 29.1 mg/dl (P = .032) and by 7.9 ± 32.7 mg/dl (P = .003) at 3 and 6 months after RDN, respectively. The change in FPG levels was related to the change in 24-h systolic BP (r = 0.286, P = .008) 3 months after RDN. Among patients with CKD, FPG levels decreased by 13.5 ± 43.5 mg/dl at 3 months (P = .043) and by 17.1 ± 45.2 mg/dl at 6 months (P = .015) following RDN. These reductions were greater compared with the non-CKD group (P = .021 and P = .024, respectively). After excluding patients on oral antidiabetic or insulin therapy, patients with CKD (but not those without CKD) exhibited a reduction in FPG levels of 6.7 ± 15.3 mg/dl (P = .043) at 6 months post-RDN. No significant changes were observed in eGFR in either group.
Conclusion: We observed that FPG levels improved to a greater extent in hypertensive patients with CKD after RDN. Thus RDN may have a broader therapeutic impact beyond blood pressure reduction in CKD patients.
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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