Efficacy of Renal Denervation for Chronic Kidney Pain: A Retrospective Study

Background: Chronic kidney pain (CKP) severely affects quality of life, leading many patients to seek opioid alternatives at tertiary care centers. Percutaneous renal denervation (RDN), approved for hypertension, may disrupt renal nociceptive fibers. We assessed the efficacy of RDN in treating refractory CKP. Methods: We retrospectively reviewed outcomes of 36 patients undergoing 43 RDN procedures at a tertiary center. Outcomes included pre/post pain scores, changes in opioid doses, complications, and subsequent interventions. Results: Forty-three procedures involved 36 patients (8 male, 28 female; mean age 40 ± 12 years). Pain was left-sided in 15 (35%), right-sided in 22 (51%), and bilateral in 5 (12%). Most procedures (92.7%) used radiofrequency ablation (Thermocool (J&J) 38 procedures; Spyral (Medtronic) in 5 procedures. Median follow-up was 14.7 months. In those with follow up, pain resolved in 11 cases, resolved and then recurrred in 9 and worsened in 6 and persisted in seven. Average pain score improved by 2.2 ± 3.7 points. Improvement was greater in obstructive/anatomic etiologies (19/29 vs. 3/11; p=0.030). Opioid use improved in 8 (33.3%), unchanged in 14 (58.3%), and worsened in 2 (8.3%). Complications included renal artery dissection in 2 patients (4.9%), one required stent. Eight patients (21%) later underwent kidney autotransplantation, 3 (4.9%) nephrectomy/transplant, 4 (10.5%) spinal cord stimulator, 1 dorsal root ganglion stimulator, 1 intrathecal opioid pump. Conclusion: RDN reduced CKP in selected patients, especially those with anatomical pain etiologies. Larger trials are needed to validate findings, refine patient selection, procedural techniques (e.g. number of ablation points in the nociceptive kill zone, device selection, location of ablation points- proximial versus distal renal arteries) to improve efficacy and durability of RDN in managing CKP. Funding: Private Foundation Support