Bilateral nephrectomy: the best, but often overlooked, treatment for refractory hypertension in hemodialysis patients

Abstract

Bilateral nephrectomy for treatment of refractory hypertension in chronic hemodialyzed patients has been infrequently carried out. We analyzed the benefits of this operation on blood pressure, clinical state, drug treatment, and quality of life. In 10 hemodialyzed patients with refractory hypertension, systolic (SBP) and diastolic (DBP) blood pressure were measured 1 month before nephrectomy bilateral and 3, 6, 9, and 12 months after. In addition, the use of antihypertensive drugs before and after surgery was evaluated. Four patients had SBP and DBP values characteristic of malignant hypertension. In all 10 patients hypertension responded neither to reduction of plasma volume by ultrafiltration nor to multiple antihypertensive drug therapy. Hypertensive crises were associated with cerebral hemorrhage in two patients, severe encephalopathy with persistent neural dysfunction in one patient, and encephalopathy and diplopia in another. Three months after bilateral nephrectomy blood pressure decreased significantly (P < .005) and was normal in nine patients. In one noncompliant patient with intradialytic body weight increases of nearly 10%, blood pressure was still elevated. Malignant or drug-resistant hypertension with hypertensive crises is an indication for bilateral nephrectomy. The clinical state and quality of life improved in all patients in the present study and antihypertensive treatment is no longer necessary.

Tonic chemoreflex activation contributes to the elevated muscle sympathetic nerve activity in patients with chronic renal failure

“…Similar sympathoinhibitory effects of nephrectomy were observed in renal transplant recipients [6]. Furthermore, bilateral nephrectomy leads to strikingly improved blood pressure control in hemodialysis patients with refractory hypertension [29].…”

The optimum approach for pre‐transplant bilateral nephrectomy in small kidneys: dorsal lumbotomy vs laparoscopy

“…Zazgornik et al. [4] analysed the benefits of bilateral nephrectomy in 10 patients (four with malignant hypertension) and reported that the blood pressure improved significantly in all patients and became normal in nine. In a recent study, Power et al.…”

“…However, refractory hypertension poorly controlled with drugs is occasionally seen. In this subset of patients, BPN has been recommended [2][3][4][5]. Open BPN was associated with high morbidity and mortality, as reported in some of earlier series [6,7], with values of 3.6-4% and 18-40%, respectively, in 1970s.…”

“…In the study by Fornara et al [9], where 11 patients after renal transplant had bilateral laparoscopic nephrectomies for uncontrolled hypertension, at a follow-up of 10.4 months the blood pressure improved significantly in 83% of patients. Zazgornik et al [4] analysed the benefits of bilateral nephrectomy in 10 patients (four with malignant hypertension) and reported that the blood pressure improved significantly in all patients and became normal in nine. In a recent study, Power et al [5] reviewed the outcomes of BPN in 10 patients and found that it resulted in a decrease in the number of doses of antihypertensive drugs in all 10.…”

Bilateral Nephrectomy, the Forgotten Measure in the Treatment of Refractory Hypertension in Patients With End-Stage Renal Disease: A Case Report and Literature Review

“…Patients with resistant and refractory HTN are at risk of significant comorbid conditions, as one study showed that patients with resistant hypertension have a 32% increase in the risk of developing ESRD, a 24% increase in the risk of myocardial ischemia, a 46% increase in the risk of heart failure, a 14% increased risk of cerebrovascular events, and a 6% increased risk of mortality. Patients with chronic kidney disease are at risk of developing HTN, resistant HTN, and refractory HTN secondary to volume overload, sympathetic overactivity, activation of the renin-angiotensin system, and arteriosclerosis, with a prevalence of 50%-60% of ESRD patients on hemodialysis being hypertensive, and a prevalence of resistant hypertension of 33.4%, 28.9%, and 15.8% in chronic kidney disease with estimated glomerular filtration rate (eGFR) levels of <45 ml/min, 45-60 ml/min, >60 ml/min, respectively [1,[3][4].…”