Kidney Week Educational Symposia-Ushering Renal Denervation from Trials into the Real World

Video Transcription

Video Summary

The session opens with disclosures and logistics, then reviews evidence on renal denervation (RDN) for hypertension. RDN uses radiofrequency, ultrasound, or ethanol to ablate renal sympathetic nerves; FDA-approved systems use radiofrequency (Spyral) and ultrasound (Paradise). After the negative SYMPLICITY HTN-3 trial, newer post-2017 sham-controlled studies with improved devices and design show modest but real BP reductions, especially in untreated or “off-med” patients. Typical ambulatory systolic BP reductions are about 5–9 mmHg with RDN vs ~0–2 mmHg with sham; effects in medicated/resistant hypertension are smaller and confounded by medication changes and adherence. A head-to-head trial found no durable differences between modalities. Safety in trials appears good, with low serious adverse event rates and no clear signal for renal artery stenosis, though follow-up is often short; registries are reassuring.<br /><br />A second talk emphasizes why early trials overestimated effects (regression to mean, office BP bias, adherence/variance) and argues cost-effectiveness depends heavily on assumptions. Patient preference studies show many prioritize reducing pill burden—even at lower BP/medication levels—while physicians tend to reserve RDN for severe/resistant cases.<br /><br />A third talk stresses team-based implementation: confirm BP with ABPM/home monitoring, optimize guideline-based triple therapy and lifestyle, assess adherence and secondary causes, image renal arteries, define inclusion/exclusion criteria (often eGFR >40), ensure operator training, and provide structured multidisciplinary follow-up. Q&A highlights uncertainty in special populations (e.g., transplant), the need for ABPM to avoid masked hypertension, and pragmatic handling of sleep apnea.

Asset Subtitle

Moderator(s): Tara Chang

Presentation(s):

Introduction - Tara Chang
Long-Term Effectiveness and Patient Perspectives of Renal Denervation: Is It Ready for the Real World? - Swapnil Hiremath
Developing a Team-Based Approach to Identifying, Screening, and Following Patients for Renal Denervation - Karen Griffin

Support is provided by an educational grant from Medtronic.

Meta Tag

Date 10/25/2024

Pathway 1 Hypertension and Cardiorenal Disorders

Session ID 493112

Session Type ES - Educational Symposium

Keywords

renal denervation

hypertension

ambulatory blood pressure monitoring

sham-controlled trials

radiofrequency ablation

ultrasound ablation

resistant hypertension

cost-effectiveness

multidisciplinary implementation