Exploring the Efficacy of Renal Denervation in Chronic Kidney Disease Patients with Resistant Hypertension: A Systematic Review

Abstract

Introduction: Resistant hypertension, affecting 30–40% of chronic kidney disease (CKD) patients, accelerates renal deterioration and is often unresponsive to pharmacological treatment. Renal denervation (RDN) has emerged as a promising intervention; however, its efficacy and safety in CKD patients remain inconsistently reported. This systematic review evaluates the role of RDN in reducing blood pressure among CKD patients with resistant hypertension.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane databases until March 2025 using PRISMA 2020 guidelines. Eligible studies included CKD patients who underwent RDN with outcomes measuring blood pressure reduction. The Cochrane RoB 2.0 tool was used to assess the risk of bias in included studies.

Results: We included a total of 9 studies showing low-moderate risk of bias, originating from various countries worldwide. Despite employing different blood pressure measurement techniques, all studies favor the use of renal denervation in decreasing mainly systolic blood pressure.

Discussion: The results support the efficacy of RDN in significantly lowering systolic blood pressure in CKD patients with resistant hypertension. Additionally, some studies indicated potential renal benefits and minimal safety concerns. However, differences in RDN techniques, CKD stages, and follow-up durations limit direct comparison and generalizability of results.

Conclusion: RDN appears to be a safe and effective adjunct therapy for resistant hypertension in CKD patients. Further large-scale, standardized trials are necessary to confirm long-term outcomes and refine patient selection criteria.