Is Renal Artery Stenting the Correct Treatmentof Renal Artery Stenosis?

Cooper, Christopher J.; Murphy, Timothy P.

doi:10.1161/circulationaha.106.619015

Cited by 37 publications

(13 citation statements)

References 115 publications

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“…5 However, since the publications of the three studies, many nephrologists favor a nihilistic approach of ' no screen, no treat, ' although up to now the number of preventable cardiovascular and renal events is unknown. 6 Th e report on atherosclerotic renovascular disease by Kalra and co-workers 7 (this issue), derived from the United States Renal Data System, mirrors the above-described process in a brilliant manner. Hazard ratios for the diagnosis of ARAS increased threefold from 1992 to 2004 in patients aged 65 years or older.…”

Section: See Original Article On Page 37mentioning

confidence: 91%

Epidemiology of atherosclerotic renal artery stenosis as a mirror of prospective trials

Krumme

2010

Kidney International

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Diagnosis and treatment of atherosclerotic renal artery stenosis (ARAS) in the elderly is a never-ending challenge for every nephrologist. Kalra et al. report that adjusted hazard ratios for ARAS increased threefold from 1992 to 2004 in 16 million United States Renal Data System participants aged 66 years or older. However, numbers of revascularizations showed a biphasic pattern with a declining number since 1999. These exciting data have to be discussed with the knowledge of recent prospective trials.

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Section: See Original Article On Page 37mentioning

confidence: 91%

Epidemiology of atherosclerotic renal artery stenosis as a mirror of prospective trials

Krumme

2010

Kidney International

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“…Demzufolge muss eine erhebliche Reduktion des renalen Blutflusses vorliegen, damit es zu einer direkten Schä-digung der Niere durch unzureichende Sauerstoffversorgung kommt. Auch wird die glomeruläre Filtration über einen weiten Druckbereich aufrechterhalten, da die induzierte Erhöhung von Angiotensin II zu einer Konstriktion des Vas efferens führt und damit einem Abfall des glomerulären Filtrationsdrucks entgegenwirkt [7].…”

Section: Pathophysiologieunclassified

Die Nierenarterienstenose

et al. 2009

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Renal artery stenosis (RAS) is both a common and progressive disease and its prevalence in patients > 65 years is 6.8%. In patients with known or suspected atherosclerosis undergoing coronary angiography, a frequency of even 11-23% is reported in the literature. Despite this high prevalence, there is an ongoing discussion about the indications for revascularization and it is currently unclear, whether renal artery revascularization reduces adverse cardiovascular and renal events. Nevertheless, the number of interventions for RAS is rising steadily, although up to 40% of patients do not profit from this intervention. This fact underlines the necessity of a thorough diagnostic work-up before intervention, integrating morphological and functional tests. For morphological evaluation, multislice computed tomography, magnetic resonance tomography or digital subtraction angiography can be done. In experienced centers, Doppler ultrasound can serve as an excellent functional tool, to assess the physiological relevance of an RAS, but also invasive measurements of pressure and flow provide valuable information about the significance of stenoses; however, these methods will have to be assessed with respect to their value to predict long-term outcome. Although percutaneous intervention of RAS is associated with a substantially lower risk of major adverse events as compared to surgery, by using contrast media this procedure holds the risk of deterioration of renal function and of a small number of procedure-dependent complications as well. Thus, a careful consideration of pros and cons of this procedure is mandatory.

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“…[ 1 ] Possible mechanisms include activation of the renin-angiotensin-aldosterone system and sympathetic nervous system, volume retention associated with renal ischemia, which are important contributors in the development of heart failure. [ 1 2 ] The study of de Silva et al . reported that RAS was associated with increased morbidity and mortality in patients with chronic heart failure during a 3-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Renal Artery Stenosis in Patients with Heart Failure

Zheng

Qiang

et al. 2015

Chinese Medical Journal

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Background:Previous data are controversial about the association of renal artery stenosis (RAS) with clinical outcome in patients with heart failure. Definition of RAS in previous studies might not be appropriate. By definition of RAS with renal duplex sonography, we investigated the association of RAS with clinical outcome in patients with heart failure.Methods:In this retrospective study, we identified 164 patients with heart failure (New York Heart Association classification ≥II; left ventricular ejection fraction <50%) who had received renal duplex sonography during hospital stay. RAS was defined as renal-aortic ratio ≥3.5 or a peak systolic velocity ≥200 cm/s (or both), or occlusion of the renal artery. Categorical data of patients were compared using the Chi-square test or Fisher's exact test. Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors.Results:Finally, 143 patients were enrolled. Median follow-up time was 32 months (1–53 months). Twenty-two patients were diagnosed as RAS by renal duplex sonography, including 13 unilateral RAS (3 left RAS, 10 right RAS) and 9 bilateral RAS. There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS. By multivariate analysis, RAS was a significant predictor for all-cause death and cardiovascular death (hazard ratio [HR] = 4.155, 95% confidence interval [CI]: 1.546–11.164, P = 0.005; and HR = 3.483, 95% CI: 1.200–10.104, P = 0.022, respectively). As for composite endpoint events, including death, nonfatal myocardial infarction, ischemic stroke or intracranial hemorrhage, rehospitalization for cardiac failure, and renal replacement therapy, only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor. RAS was not a significant predictor for composite endpoint events.Conclusions:Our data suggested that RAS is associated with a poorer clinical outcome in patients with heart failure.

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Is Renal Artery Stenting the Correct Treatmentof Renal Artery Stenosis?

Cited by 37 publications

References 115 publications

Epidemiology of atherosclerotic renal artery stenosis as a mirror of prospective trials

Epidemiology of atherosclerotic renal artery stenosis as a mirror of prospective trials

Die Nierenarterienstenose

Analysis of Renal Artery Stenosis in Patients with Heart Failure

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