title: Comparison of unilateral renal artery embolization versus bilateral for treatment of severe refractory hypertension in hemodialysis patients.
abstract: OBJECTIVE
  Hypertension in ESRD patients is common, and often refractory to common medical interventions. Bilateral renal embolization (BRE) is an alternative to nephrectomy in treating severe refractory hypertension in hemodialysis patients, but has drawbacks in residual renal function preservation and post-infarction syndrome. We evaluated the efficacy and safety of unilateral renal embolization (URE) for the treatment of severe refractory hypertension in hemodialysis patients.
  
  
  METHODS
  From January 2000 to May 2007, 16 hemodialysis patients with severe refractory hypertension were randomized to URE or BRE group, and received percutaneous transcatheter unilateral or bilateral renal embolization, respectively. The efficacy and complications of these two procedures were compared. The plasma renin activity (PRA), plasma angiotensin II, aldosterone and endothelin-1 (ET-1) were measured pre- and post-renal embolization in both groups.
  
  
  RESULTS
  The procedures were completed successfully without severe immediate complications. The blood pressure decreased from 211/122 to 127/81 mmHg in URE group (P < 0.0001), and in BRE group from 208/117 to 124/76 mmHg (P < 0.0001) with significantly reduced need for antihypertensive medications. The residual renal function was reasonably kept and post-infarction syndrome was milder in URE group compared with BRE group. No activation of RAS was observed in this series and no RAS activity dynamic change occurred post-procedure. Decreased circulating ET-1 was accompanied with the lowering of blood pressure after the procedure (P < 0.0001).
  
  
  CONCLUSIONS
  Unilateral renal embolization is as effective as BRE in treating severe refractory hypertension in hemodialysis patients, with advantages over BRE in residual renal function preservation and milder post-infarction syndrome.
authors.affiliation: Division of Nephrology, Changzheng Hospital, Second Military Medical University, 200003 Shanghai, China. archermao111@yahoo.com.cn
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Mao
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Ye
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
authors.forename: Xuezhi
authors.initials: X
authors.lastname: Zhao
authors.forename: Yuqiang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Chenggang
authors.initials: C
authors.lastname: Xu
authors.forename: Linlin
authors.initials: L
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.forename: Huimin
authors.initials: H
authors.lastname: Li
authors.forename: Weihua
authors.initials: W
authors.lastname: Dong
authors.forename: Sheng
authors.initials: S
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery; D006435:Renal Dialysis; D012720:Severity of Illness Index