319Baroreflex Activation Therapy in CKD
Based on the pathophysiological evidence described above (i.e., SNS overactivity
and the impaired baroreflexes in CKD and the role of baroreflexes in blood pressure
regulation), the use of BAT in the treatment of CKD patients is worth to study. The
aim of BAT in CKD patients might be both renoprotection and improved blood
pressure control.
There is only single preliminary clinical study evaluating the effect of BAT on
kidney function in CKD patients (Table 19.2). Wallbach et al. studied prospectively
23 CKD patients with resistant hypertension. The evaluation of kidney function
and proteinuria was done before and 6 months after Barostim system implantation.
It was found that BAT improved renal function (eGFR increase from 54 to 60 ml/
min) and reduced proteinuria (from 284 to 136 mg/g creatinine) [ 25 ]. These pre-
liminary results showed a potentially nephroprotective effect of BAT in hyperten-
sive CKD patients.
Two preliminary clinical studies evaluated the effect of BAT on blood pressure in
CKD patients. Wallbach et al. in already-quoted study have shown that BAT is an
effective antihypertensive treatment in hypertensive CKD (Table 19.2). The reduc-
tion of blood pressure in this study (mean BP was reduced from 117 to 104 mmHg)
was comparable with the achieved in the already-quoted studies with non-CKD
patients [ 25 ]. Recently, Beige et al. in preliminary clinical study demonstrated that
BAT is well tolerated and effective nonpharmacological, interventional, antihyper-
tensive therapy in hemodialysis CKD patients with resistant hypertension [ 26 ]. In
this study in six hemodialysis patients, Barostim neo system was implanted. At the
baseline, SBP was 194 mmHg and DBP 97 mmHg. Twelve months BAT leads to
SBP reduction to 137 mmHg and DBP reduction to 73 mmHg.
Described above the promising results of preliminary clinical studies suggest
that in CKD patients, BAT is characterized by some nephroprotective effect and that
BAT is an effective antihypertensive treatment in this group of patients need to be
confirmed in the further studies.
Conclusions
Patients with chronic kidney disease are characterized by sympathetic nervous sys-
tem hyperactivity, which leads to hypertension and/or organ damage. Experimental
and clinical studies have shown that reduction in sympathetic nervous system
activity with pharmacological treatment, catheter-based renal denervation, or
baroreceptor activation inhibits the progression of chronic kidney disease and
improves renal function and survival. However, properly planned and performed
randomized clinical trials are still needed in order to confirm the clinical value of
this type of treatment.
19 Devices for Neural Modulation (Renal Denervation, Barostimulation)