Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis

Abstract

Background Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS. Methods From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of ‘kidney function improvement’ or ‘hypertension improvement’ after PTA/S were classified as responders. Results Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S ( P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10–45) mL/min/1.73 m 2 to 41 (IQR, 16–67) mL/min/1.73 m 2 at 4 months after PTA/S, although the difference was not significant ( P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively ( P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150–164) mmHg to 140 (IQR, 131–148) mmHg at 4 months after PTA/S ( P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group ( P = 0.004). Conclusion PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.

Determinants of long-term outcome in patients after percutaneous stent-assisted intervention on renal artery steno-occlusive atherosclerotic disease

“…There is an ongoing debate as to which patients are likely to respond to renal artery stenting (in terms of improvement in kidney function or hypertension) and which patients are not. In a study by Kim et al, 39 patients with a high -risk profile at baseline (defined as having 1 or more of the following:…”

Simple clinical scores to predict blood pressure and renal function response to renal artery stenting for atherosclerotic renal artery stenosis

“…However, the predictive accuracy of such a simplified approach is in the order of ≈50%. [11,19,28]. Using another approach, Modrall and colleagues have recently identified the following independent predictors of a positive BP response: requirement for four or more medications (OR 5.9; P < 0.001), preprocedural diastolic BP >90mmHg (OR 13.9; P < 0.001), and preprocedural clonidine use (OR 4.52; P = 0.008) but they have not translated those into a prediction score [27].…”

Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease

“…The immediate result of PTA is characterised by a high success rate and fairly low periprocedural complication rate [5][6][7]. However, the clinical improvement following PTA of RAS is uncertain [5][6][7][8]. The effect of PTA is probably a complex issue, as both the effect of PTA on renal function and systolic/diastolic blood pressure (SBP/ DBP), as well as cardiovascular adverse events is at least controversial [6,9,10].…”

“…Furthermore, the long-term result of PTA is limited by the unwelcome occurrence of recurrent stenosis (RS) that may additionally impact the final effect of PTA. The RS rate following RAS procedures is estimated at 6-40% [5][6][7][8]11]. However, the determinants of RS are poorly established.…”