Blood pressure and renal outcomes after renal denervation in patients with chronic kidney disease

BACKGROUND: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of renal denervation (RDN) in patients with chronic kidney disease (CKD), including those with end-stage renal disease requiring dialysis and resistant hypertension. METHODS: A comprehensive search of PubMed, Embase, Scopus, and Cochrane databases was performed from inception to August 2025. Eligible studies included randomized trials, non-randomized clinical trials, and prospective observational cohorts enrolling adult CKD patients undergoing RDN. The primary outcomes were changes in office and 24-hour ambulatory blood pressure (BP). Secondary outcomes included changes in estimated glomerular filtration rate and safety endpoints. Data were synthesized using random-effects meta-analysis, with heterogeneity assessed by I2 and publication bias evaluated by Egger test. This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool for randomized controlled trials and the RoB In Non-randomized Studies of Interventions-I tool for non-randomized studies. RESULTS: Twelve studies involving 202 patients with CKD stages 2 to 5, including dialysis populations, were analyzed. Pooled results demonstrated significant reductions in office systolic BP (-20 mm Hg) and diastolic BP (-8 mm Hg), as well as ambulatory systolic (-15 mm Hg) and diastolic BP (-6 mm Hg). Renal function remained stable, with no evidence of accelerated decline in estimated glomerular filtration rate. Safety analysis revealed a low incidence of complications, limited to isolated access-site events, with no excess risk of renal artery stenosis. Heterogeneity was moderate (I2 = 58%), while Egger test indicated no significant small-study effects (P = .33). CONCLUSION: RDN effectively lowers BP in CKD patients without compromising renal function and demonstrates an acceptable safety profile, supporting its role as an adjunctive therapy in resistant hypertension.