Application of percutaneous renal denervation in hemodialysis patients with resistant hypertension: a case report and literature review

Background Patients undergoing hemodialysis frequently suffer from refractory resistant 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 generally restricted in routine randomized clinical trials for patients whose estimated glomerular filtration rate (eGFR) is below 40 mL/min/1.73 m² due to historical screening criteria emphasizing potential contrast-related events and a substantial lack of large-scale evidence. In this study, we evaluated the application of a novel multi-electrode grid RDN technology to maintenance hemodialysis patients with severe treatment-resistant hypertension. Since these patients underwent regular hemodialysis, contrast medium could be cleared efficiently, bypassing the risk of contrast-induced nephropathy. This evaluation provides important exploratory clinical evidence regarding alternative management pathways in this high-risk subpopulation. Case presentation In this case series, we present two cases of percutaneous RDN in hemodialysis patients with resistant hypertension using the Netrod ® RDN system. Case 1 presented with a complicated pharmacological regimen optimized for underlying heart failure with preserved ejection fraction (HFpEF). Case 2 presented with concurrent atherosclerotic renal artery stenosis affecting the right polar branches, which was managed via simultaneous percutaneous transluminal renal angioplasty (PTRA). Prior to surgery, comprehensive examinations were performed to rule out other secondary causes, while also excluding hemorrhagic risks and drug allergies. Following the procedures, both patients achieved robust, long-term stabilization of blood pressure trajectories alongside a profound consolidation of oral anti-hypertensive pill burdens (Figs. 1, 2, 3, 4, 5, 6, 7 and 8). Conclusions RDN technology using a basket-shaped multi-electrode grid configuration showed potential for improving blood pressure control and reducing antihypertensive medication burden in two carefully selected hemodialysis patients with resistant hypertension. However, given the limited sample size and the presence of concurrent mechanical intervention in one patient, further large-scale studies are required to validate its safety and efficacy. Clinical trial number Not applicable.