Study characteristics

The PRISMA chart presented in Fig. 1 outlines the results of the literature screen. 11 studies, with a total of 226 patients, were utilized in the synthesis of this analysis [22,23,24,25,26,27,28,29,30,31,32]. Baseline study characteristics are summarized in Table 1. Table 2 outlines the inclusion criteria, CKD stage, surgical characteristics, and methods of drug adherence assessment.

Table 1 Study design and baseline characteristics of included Studies.Table 2 Study methodology and procedural specifications of included studies.

Mean ages ranged from 42.5 ± 13.8 to 66 ± 9 years and follow-up ranged from 6 to 24 months. At baseline the number of anti-HTN medications ranged from 2.63 ± 2.62 to 6.2 ± 1.1 (Table 1). Supplementary Table 2 outlines the hypertensive agents by class at baseline within the included studies (Supplementary Table 2). The number of patients in each CKD stage were: 0 stage 1, 19 stage 2, at least 33 stage 3, at least 20 stage 4, at least 40 stage 5. Two studies included patients with stage 3 and 4 CKD but did not report the number in each stage (n = 28) and another study included patients with stage 3, 4, and 5 CKD but did not report the number in each stage (n = 46) (Table 2).

Effect of RDN on office blood pressureSystolic office blood pressure at 6 months

Six studies reported systolic office blood pressure (OBP) outcomes at 6 months [23, 24, 26, 28, 29, 31]. Five studies reported a significant decrease in OBP at 6 months (Table 3) [23, 24, 26, 29, 31]. Pooled analysis of the studies showed a significant decrease in systolic OBP at 6 months compared to baseline, with MD of −24.9 mm Hg (p = 0.0004) and a I2 value of 87% (Fig. 2A). Heterogeneity was decreased to 53% following removal of Kiuchi 2015 study. Significance was still maintained with the pooled analysis showing a decrease in systolic OBP compared to baseline (MD = −19.8 mm Hg, p < 0.00001) (Fig. 2B).

Table 3 Office and ambulatory blood pressure outcomes of included studies.Fig. 2: Forest plot of the effects of renal denervation on office systolic blood pressure.

A 6 month; B 6 month sensitivity analysis after removal of Kiuchi 2015; C 12 month; D 12 month sensitivity analysis after removal of Kiuchi 2015. IV inverse variance, df degrees of freedom.

Systolic office blood pressure at 12 months

Six studies reported systolic OBP outcomes at 12 months [24, 25, 28, 29, 31, 32]. Four studies reported a significant decrease in OBP at 12 months (Table 3) [24, 26, 29, 31]. Pooled analysis of the studies showed a significant decrease in systolic OBP at 12 months compared to baseline, with MD of −27.5 mm Hg (p = 0.0001) and a I2 value of 89% (Fig. 2C). Heterogeneity decreased to 40% following removal of Kiuchi 2015 study. Significance was still maintained with the pooled analysis showing a decrease in systolic OBP compared to baseline (MD = −21.2 mm Hg, p < 0.00001) (Fig. 2D).

Diastolic office blood pressure at 6 months

Five studies reported diastolic OBP outcomes at 6 months [23, 26, 28, 29, 31]. Three studies reported a significant decrease in OBP at 6 months (Table 3) [23, 26, 31]. Pooled analysis of the studies showed a significant decrease in diastolic OBP at 6 months compared to baseline, with MD of −11.8 mm Hg (p = 0.003) and a I2 value of 69% (Fig. 3A). Heterogeneity decreased to 39% following removal of Prasad 2019 study. Significance was still maintained with the pooled analysis showing a decrease in diastolic OBP compared to baseline (MD = −15.2 mm Hg, p < 0.00001) (Fig. 3B).

Fig. 3: Forest plot of the effects of renal denervation on office diastolic blood pressure.

A 6 month; B 6 month sensitivity analysis after removal of Prasad 2019; C 12 month; D 12 month sensitivity analysis after removal of Kiuchi 2015. IV inverse variance, df degrees of freedom.

Diastolic office blood pressure at 12 months

Five studies reported diastolic OBP outcomes at 12 months [25, 26, 29, 31, 32]. Three studies reported a significant decrease in OBP at 12 months (Table 3) [25, 26, 31]. Pooled analysis of the studies showed a significant decrease in systolic OBP at 12 months compared to baseline, with MD of −12.7 mm Hg (p = 0.0003) and a I2 value of 72% (Fig. 3C). Heterogeneity decreased to 36% following removal of Kiuchi 2015 study. Significance was still maintained with the pooled analysis showing a decrease in diastolic OBP compared to baseline (MD = −9.86 mm Hg, p = 0.0005) (Fig. 3D).

Effect of RDN on 24-hour ambulatory blood pressureSystolic 24-hour ambulatory blood pressure at 6 months

Seven studies reported systolic 24-hour ambulatory blood pressure (ABP) outcomes at 6 months [23, 26,27,28,29,30,31]. Three studies reported a significant decrease in systolic 24-hour ABP at 6 months (Table 3) [26, 30, 31]. Pooled analysis of the studies showed a significant decrease in systolic 24-hour ABP at 6 months compared to baseline, with MD of −9.77 mm Hg (p = 0.05) and a I2 value of 83% (Fig. 4A). Sensitivity analysis did not reduce heterogeneity or alter significance.

Fig. 4: Forest plot of the effects of renal denervation on ambulatory systolic blood pressure.

A 6 month; B 12 month; C 24 month; D 24 month sensitivity analysis after removal of Prasad 2019. IV inverse variance, df degrees of freedom.

Systolic 24-hour ambulatory blood pressure at 12 months

Seven studies reported systolic 24-hour ABP outcomes at 12 months [22, 25,26,27, 29, 31, 32]. Four studies reported a significant decrease in systolic 24-hour ABP at 12 months (Table 3) [22, 25, 26, 31]. Pooled analysis of the studies showed a significant decrease in systolic 24-hour ABP at 12 months compared to baseline, with MD of −13.42 mm Hg (p = 0.0007) and a I2 value of 73% (Fig. 4B). Sensitivity analysis did not reduce heterogeneity or alter significance.

Systolic 24-hour ambulatory blood pressure at 24 months

Three studies reported systolic 24-hour ABP outcomes at 24 months [26, 27, 29]. Two studies reported a significant decrease in 24-hour ABP at 24 months (Table 3) [26, 27]. Pooled analysis of the studies failed to show a significant decrease in 24-hour ABP at 24 months compared to baseline, with MD of −6.61 mm Hg (p = 0.47) and a I2 value of 88% (Fig. 4C). Heterogeneity decreased to 41% following the removal of Prasad 2019 study. The pooled analysis showed a significant decrease in systolic 24-hour ABP compared to baseline, MD of −16.30 mm Hg (p = 0.0002) (Fig. 4D).

Diastolic 24-hour ambulatory blood pressure at 6 months

Seven studies reported diastolic 24-hour ABP outcomes at 6 months [23, 26,27,28,29,30,31]. Three studies reported a significant decrease in 24-hour ABP at 6 months (Table 3) [26, 30, 31]. Pooled analysis of the studies showed a significant decrease in 24-hour ABP at 6 months compared to baseline, with MD of −5.62 mm Hg (p = 0.03) and a I2 value of 63% (Fig. 5A). Heterogeneity decreased to 37% following the removal of Scalise 2020 study. Significance was no longer maintained following the sensitivity analysis, MD of −3.64 mm Hg (p = 0.09) (Fig. 5B).

Fig. 5: Forest plot of the effects of renal denervation on ambulatory diastolic blood pressure.

A 6 month; B 6 month sensitivity analysis after removal of Scalise 2020; C 12 month; D 24 month; E 24 month sensitivity analysis after removal of Prasad 2019. IV inverse variance, df degrees of freedom.

Diastolic 24-hour ambulatory blood pressure at 12 months

Seven studies reported diastolic 24-hour ABP outcomes at 12 months [22, 25,26,27, 29, 31, 32]. Five studies reported a significant decrease in 24-hour ABP at 12 months (Table 3) [22, 25,26,27, 31]. Pooled analysis showed a significant decrease in 24-hour ABP at 12 months compared to baseline, with MD of −6.30 mm Hg (p = 0.001) and a I2 value of 43% (Fig. 5C).

Diastolic 24-hour ambulatory blood pressure at 24 months

Three studies reported diastolic 24-hour ABP outcomes at 24 months [26, 27, 29]. Two studies reported a significant decrease in 24-hour ABP at 24 months (Table 3) [26,