BILATERAL-NEPHRECTOMY - THE BEST, BUT OFTEN OVERLOOKED TREATMENT FOR REFRACTORY HYPERTENSION IN HEMODIALYSIS-PATIENTS

Bilateral nephrectomy for treatment of refractory hypertension in chro nic hemodialyzed patients has been infrequently carried out. We analyz ed the benefits of this operation on blood pressure, clinical state, d rug treatment, and quality of life. In 10 hemodialyzed patients with r efractory hypertension, systolic (SBP) and diastolic (DBP) blood press ure were measured 1 month before nephrectomy bilateral and 3, 6, 9, an d 12 months after. Tn addition, the use of antihypertensive drugs befo re and after surgery was evaluated. Four patients had SEP and DBP valu es characteristic of malignant hypertension, In all 10 patients hypert ension responded neither to reduction of plasma volume by ultrafiltrat ion nor to multiple antihypertensive drug therapy. Hypertensive crises were associated with cerebral hemorrhage in two patients, severe ence phalopathy with persistent neural dysfunction in one patient, and ence phalopathy and diplopia in another. Three months after bilateral nephr ectomy 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. Ma lignant or drug-resistant hypertension with hypertensive crises is an indication for bilateral nephrectomy, The clinical state and quality o f life improved in all patients in the present study and antihypertens ive treatment is no longer necessary. (C) 1998 American Journal of Hyp ertension, Ltd.