Diabetes mellitus does not preclude stabilization or improvement of renal function after stent revascularization in patients with kidney insufficiency and renal artery stenosis

Silva, José A.; Potluri, Srinivas; White, Christopher J.; Collins, Tyrone J.; Jenkins, J. Stephen; Subramanian, Rajesh; Ramee, Stephen R.

doi:10.1002/ccd.20980

Cited by 10 publications

(6 citation statements)

References 27 publications

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“…The current literature contains conflicting reports on the role and efficacy of stent placement for the therapy of RAS in-patient with diabetes mellitus. [38, 40, 41]. The findings in this study are consistent with those that were observed in ASTRAL and CORAL.…”

Section: Discussionsupporting

confidence: 91%

Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease

Misra

Khosla

Allred

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose To identify the risk factors for progression to renal replacement therapy (RRT) and all-cause mortality in patients who underwent renal artery (RA) stent placement for atherosclerotic renal artery stenosis (RAS). Materials and Methods A retrospective study was performed from June 1996 to June 2009 that identified 1052 patients that underwent RA stent placement. The glomerular filtration rate at the time of RA stent placement was estimated from the serum creatinine level and divided into renal disease stages 1–5. Univariate and multivariable Cox proportional hazards models were used to determine which factors were associated with each endpoint. Results The times to progression to all-cause mortality and RRT were similar for chronic kidney (CKD) stages 1/2/3A and served as the reference group. In multivariable analysis, high-grade proteinuria (P<.001), higher CKD stage [stage 5 vs. 1-3A, (P<.001)], stage 4 vs. 1-3A, (P<.001), stage 3B vs. 1-3A, (P=.02)] remained independently associated with increased risk of progression to RRT. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) use was associated with decreased risk of progression to RRT (P=0.03). Higher CKD stage [stage 5 vs. 1-3A, (P<.001), stage 4 vs. 1-3A (P=.004), carotid artery disease (P<.001), diabetes mellitus (P=.002), and high-grade proteinuria (P<.001) remained independently associated with all-cause mortality. Statin use was associated with decreased risk of all-cause mortality (P< 0.001). Conclusion Based on this analysis, patients with atherosclerotic RAS who undergo RA stenting who have high-grade proteinuria and CKD stage 3B, 4 or 5 have an increased risk of progression to RRT. Patients with high-grade proteinuria, CKD stage 3B, 4 or 5, carotid disease or diabetes have an increased risk for all-cause mortality after renal artery stenting. ACEi/ARB use in this patient population has a decreased risk of progression to RRT and patients on statins have a decreased risk of all-cause mortality.

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Section: Discussionsupporting

confidence: 91%

Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease

Misra

Khosla

Allred

et al. 2016

Journal of Vascular and Interventional Radiology

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“…43 In contrast, there have been several studies reporting the majority of patients to either have a stabilization or improvement of sCr after RASt. [14][15][16][17][18][19][20][21][23][24][25][26][27][28][29] The major concern is the proportion of patients with worsening renal function after RASt. An obvious concern during RASt is the potential of embolization secondary to interaction with the plaque during the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…12 There is compelling observational data that RASt stabilizes or improves renal function for patients with ARAS. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The objective of our study was to identify predictors of renal function outcome after RASt, and to assess overall changes in renal function after RASt.…”

mentioning

confidence: 99%

Serum Creatinine Stabilization Following Renal Artery Stenting

Bates

Campbell

Broce³

et al. 2008

Vasc Endovascular Surg

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The impact of renal artery stenting on renal function in a subgroup of consecutive de novo patients with atherosclerotic renal artery stenosis from the single operator, single center, retrospective renal stent trial is defined. Patients with inadequate preprocedure and/or follow-up renal function studies were excluded. Abnormal baseline serum creatinine (sCr) was defined as > or = 1.5 mg/dL. Follow-up sCr was improved, unchanged, or worsened if the variance from baseline decreased by >20%, stayed within 20%, or increased >20%, respectively. For the total cohort (194 patients), renal function stabilized or improved in 72% of patients. Plotting 1/sCr demonstrated a decline in renal function before the procedure that stabilized following renal artery stenting. Bilateral renal artery stenting predicted normal follow-up sCr, and baseline sCr >2.1 mg/dL was associated with improvement in sCr long-term. In conclusion, renal artery stenting results in overall stabilization of renal function, and bilateral renal artery stenting seems to have added benefit.

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“…[1][2][3][4] Balloon-expandable stents are primarily utilized to treat ostial lesions, while angioplasty alone has been advocated for more distal lesions. 5 Recently, pure endovascular treatment of juxtarenal and thoracoabdominal aneurysms has been described.…”

mentioning

confidence: 99%

Revised duplex criteria and outcomes for renal stents and stent grafts following endovascular repair of juxtarenal and thoracoabdominal aneurysms

Mohabbat

Greenberg

Mastracci

et al. 2009

Journal of Vascular Surgery

114

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Diabetes mellitus does not preclude stabilization or improvement of renal function after stent revascularization in patients with kidney insufficiency and renal artery stenosis

Abstract: Renal artery stent placement appears to be equally beneficial in preserving renal function in DM and NDM patients with ischemic nephropathy and global renal ischemia.

Cited by 10 publications

References 27 publications

Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease

Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease

Serum Creatinine Stabilization Following Renal Artery Stenting

Revised duplex criteria and outcomes for renal stents and stent grafts following endovascular repair of juxtarenal and thoracoabdominal aneurysms

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