# Carbon Dioxide Angiography–Guided Ultrasound Renal Denervation in Refractory Hypertension With Chronic Kidney Disease

## TL;DR

A new method using carbon dioxide angiography during ultrasound renal denervation is shown to be safe for patients with kidney disease and high blood pressure.

## Contribution

The paper introduces CO2 angiography as a safer alternative to traditional contrast agents in renal denervation for patients with chronic kidney disease.

## Key findings

- CO2 angiography successfully visualized renal arteries without nephrotoxic effects.
- The procedure led to reduced antihypertensive medication and improved kidney function in a patient with CKD.

## Abstract

Renal denervation (RDN) is an emerging therapy for resistant hypertension. However, use of iodinated contrast during the procedure raises concern for contrast-induced kidney injury in patients with chronic kidney disease (CKD). Carbon dioxide (CO2) angiography may provide a safer alternative.

An 85-year-old man with stage 3a CKD and refractory hypertension despite 5 medications underwent ultrasound-guided RDN (uRDN). After minimal iodinated contrast for access confirmation, CO2 angiography was used to visualize the bilateral renal arteries and guide ablation. Three ablations were delivered to each artery, and the procedure was uneventful. At 5-week follow-up, serum creatinine improved (1.3 mg/dL), and antihypertensive therapy was reduced from 5 to 3 agents.

CO2 angiography allows safe renal artery visualization without nephrotoxic exposure, making it particularly valuable in CKD patients where contrast-induced injury is a concern.

CO2-guided uRDN is a safe, non-nephrotoxic option for refractory hypertension in patients with CKD.