Application of Percutaneous Renal Denervation in Hemodialysis Patients with Malignant Hypertension: A Case Report and Literature Review

Background: Patients undergoing hemodialysis frequently suffer from refractory hypertension, a condition that proves challenging to manage even when conventional antihypertensive drugs are administered in sufficient doses. This situation places considerable strain on the cardiovascular and cerebrovascular systems. In recent times, the effectiveness as well as the safety of percutaneous renal denervation (RDN) have gained recognition. Nevertheless, its utilization is not advised for patients whose estimated glomerular filtration rate (eGFR) is below 40 mL/min/1.73 m², owing to the side effects associated with contrast agents. In this study, we applied RDN technology to hemodialysis patients with refractory hypertension, which represents an innovative application. Since these patients underwent regular hemodialysis, there was no need to worry about contrast-induced nephropathy. This provides an effective antihypertensive treatment option for such patients. This academic report is the first systematic report in China on the application of RDN technology in hemodialysis patients with refractory hypertension. Case presentation: In this case series, we used the Netrod® RDN system and presented two cases of percutaneous renal denervation in hemodialysis patients with malignant hypertension. Prior to surgery, comprehensive examinations were performed on the patient to rule out secondary hypertension factors such as primary aldosteronism and renal artery stenosis, while also excluding risks including hemorrhagic risks and drug allergies. Following the RDN treatment, the patients' blood pressure dropped steadily, and the amount of orally administered antihypertensive drugs was considerably reduced. Conclusions: RDN technology can safely and effectively reduce blood pressure in hemodialysis patients with refractory hypertension, decrease the use of oral antihypertensive drugs, and potentially reduce the incidence of cardiovascular and cerebrovascular adverse events in these patients, which is worthy of promotion and reference.