Bilateral Renal Artery Embolization for Managing Uncontrolled Hypertension in A Haemodialysis Patient: An Alternative...

Patients with end stage renal disease who have resistant or refractory hypertension (HTN) sometimes require bilateral nephrectomy to control their blood pressure. This treatment strategy is effective but is sometimes associated with morbidity and mortality and is costly. We report a case of a 65-year-old male on haemodialysis who developed refractory HTN, uncontrolled even with 7 antihypertensive drugs. He also had decompensated chronic liver disease and was a poor surgical candidate. He underwent bilateral renal artery chemoembolization as an alternative to bilateral nephrectomy and his BP significantly improved resulting in reduction of his antihypertensive therapy from 7 to 3 drugs. We report this case as an alternative approach to controlling resistant HTN in the haemodialysis population.

Bilateral nephrectomy is an established option for blood pressure control in patients with end-stage renal disease and refractory hypertension, however, is associated with certain risks.Bilateral renal artery embolization is a minimally invasive alternative, particularly in patients who are poor surgical candidates.This approach may reduce the antihypertensive burden significantly and should be considered in multidisciplinary management of refractory hypertension in dialysis patients.