Catheter-based renal denervation as therapy for chronic severe kidney-related pain

Abstract

Background. Loin pain haematuria syndrome (LPHS) and autosomal dominant polycystic kidney disease (ADPKD) are the most important non-urological conditions to cause chronic severe kidney-related pain. Multidisciplinary programmes and surgical methods have shown inconsistent results with respect to pain reduction. Percutaneous catheter-based renal denervation (RDN) could be a less invasive treatment option for these patients. Methods. Our aim was to explore the change in perceived pain and use of analgesic medication from baseline to 3, 6 and 12months after RDN. Patients with LPHS or ADPKD, who experienced kidney-related pain ≥3months with a visual analogue scale (VAS) score ≥50/100 could be included. Percutaneous RDN was performed with a single-electrode radiofrequency ablation catheter. Results. RDN was performed in 11 patients (6 with LPHS and 5 with ADPKD). Perceived pain declined in the whole group by 23mm (P=0.012 for the total group). In patients with LPHS and ADPKD, the median daily defined dosage of analgesic medication decreased from 1.6 [interquartile range (IQR) 0.7- 2.3] and 1.4 (IQR 0.0-7.4) at baseline to 0.3 (IQR 0.0-1.9; P=0.138) and 0.0 (IQR 0.0-0.8; P=0.285) at 12months, respectively. Mean estimated glomerular filtration rate decreased in the whole group by 5.4mL/min/1.73 m2 at 6months compared with baseline (P=0.163). Conclusions. These results suggest that percutaneous catheterbased RDN reduces pain complaints and the use of analgesic medication in patients with LPHS or ADPKD. The present results can serve as the rationale for a larger, preferably randomized (sham) controlled study.