JACC Case Rep. 2026 Oct 27:110865. doi: 10.1016/j.jaccas.2026.110865. Online ahead of print.
ABSTRACT
BACKGROUND: Hypertension is often poorly controlled in patients with end-stage renal disease on hemodialysis, and evidence for renal denervation in this population remains limited.
CASE SUMMARY: We describe a 38-year-old man with end-stage renal disease on hemodialysis because of thrombotic microangiopathy who developed refractory hypertension with recurrent hypertensive emergencies despite 6 antihypertensive agents and aggressive ultrafiltration, precluding kidney transplant listing. After a thorough secondary hypertension work-up, he underwent off-label catheter-based bilateral renal denervation, after which his blood pressure improved substantially, hypertensive emergencies ceased, and he was subsequently added to the transplant waitlist.
CONCLUSION: Renal denervation may serve as adjunctive therapy to help dialysis patients with resistant hypertension reach transplant candidacy.
TAKE-HOME MESSAGES: Understand the limitations of pharmacologic and dialytic therapy for blood pressure control in dialysis-dependent patients. Appreciate how refractory hypertension may serve as a barrier to kidney transplant listing and how renal denervation may address it.
PMID:42949689 | DOI:10.1016/j.jaccas.2026.110865