Kidney Denervation

Kidney denervation has emerged as an interventional treatment for the ever-increasing prevalence of uncontrolled hypertension that recently garnered Unites States Food and Drug Administration approval. Kidney denervation is a minimally invasive catheter-based procedure that ablates the sympathetic nerves around the kidney arteries using a variety of modalities. Clinical trial data have generally demonstrated that kidney denervation is a safe procedure, but efficacy data are mixed. In addition, important populations were excluded from these trials, including patients with advanced CKD and kidney transplants. Currently, it is still unclear which patients with hypertension will have an appropriate therapeutic effect after undergoing kidney denervation, and there is no available biomarker to assist in predicting a patient's blood pressure response after kidney denervation. When considering when to offer kidney denervation, patients should ideally be evaluated by a multidisciplinary team with the proper expertise to evaluate the appropriateness of the referral and discuss the risks and benefits to allow for shared decision-making. Ongoing and future studies will help to address current unanswered questions that remain about longer-term safety and efficacy of kidney denervation, particularly in populations poorly represented by current trials. Kidney denervation can be an important therapy that can be used to complement antihypertensive medications and lifestyle changes to improve hypertension control.