Long‐term renal function preservation after renal artery stenting in patients with progressive ischemic nephropathy

Abstract

We assessed the long-term effect of successful renal artery stent revascularization on renal function, blood pressure control, and survival in patients with progressive renal dysfunction due to ischemic nephropathy. Ischemic nephropathy presents a potentially serious risk of complete loss of renal function. Surgical renal revascularization is associated with significant risk of mortality/morbidity in this patient population. The potential role and long-term effect of renal artery stent revascularization in this patient population is not well defined. A cohort of 51 patients (mean age, 72 years; 52.9% men) with progressive azotemia, defined as a preprocedure serum creatinine (Scr) value of >or= 1.5 mg/dl and a negative slope of the reciprocal 1/Scr curve during the 12 months preceding revascularization, underwent successful primary stent deployment in 93 atherosclerotic renal artery lesions (42 bilateral, 9 solitary kidneys). Estimated glomerular filtration rate (EGFR) and serum creatinine values, blood pressure, antihypertensive medication requirements, and survival rates were monitored over a mean of 30-month follow-up. Renal artery duplex Doppler or renal angiography were performed at a mean of 13 months (range, 7-15 months) to assess stent patency. Stent implantation was successful in 92/93 (98.9%) stenotic renal arteries (mean preprocedure serum creatinine 2.3 +/- 0.9 mg/dl; range, 1.5-8.2 mg/dl). Forty-seven patients were eligible for 30-month follow-up of the procedural effect on renal function, blood pressure control, number of antihypertensive medications, and survival. At 1-year follow-up, the slope of the 1/Scr curve increased and the EGFR values significantly improved compared to preprocedure values (19.9 +/- 6.2 to 26.8 +/- 10.1 ml/min; P < 0.0001), serum creatinine decreased from the mean preprocedure value to 1.75 +/- 0.69 mg/dl (P < 0.001), with renal function improvement or stabilization observed in 94% of patients; three patients (7.3%) required permanent hemodialysis during the 30-month follow-up period. Systolic and diastolic blood pressure significantly decreased (from 177 +/- 28 to 148 +/- 25 mm Hg and from 92 +/- 15 to 78 +/- 14 mm Hg, respectively; P < 0.001) with fewer antihypertensive medications required to control blood pressure (3.5 +/- 0.9 vs. 1.9 +/- 1.3; P < 0.001). The patient survival rate after 30-month follow-up was 87%, with three deaths related to end-stage renal failure. Renal artery stent revascularization reversed progressive renal dysfunction within the first 12 months and maintained the improved level of renal function at 30-month follow-up while improving blood pressure control and reducing the number of antihypertensive medication requirements. Renal stent revascularization should be considered a valid therapeutic option for the long-term treatment of ischemic nephropathy.

<b>Effect of Renal Artery Stenting on Renal Function in Patients With Ischemic Nephropathy</b>

“…We excluded patients who would not benefit from renal revascularization (ie, patients with significant renal atrophy and azotemia with unilateral renovascular disease and bilateral functioning kidneys). Rocha-Singh, et al 16) , who had similar criteria as ours, observed similar results. Rodriguez, et al 26) observed the stent had no effect on renal function, in their hypertensive patient population that had normal renal function.…”

“…The effectiveness of renal intervention has been previously reported to be 42-91%. 10,12,14,16,22,26) In contrast, van Jaarsueld, et al randomized 106 cases into a drug or angioplasty group and observed no difference between the groups. 27) However, in their study, in 44% of the cases, renal angioplasty had been performed for uncontrolled hypertension despite a combination of three medications.…”

“…16) Stenting: All patients received aspirin and ticlopidine or clopidogrel before the procedure. They also received a heparin bolus or infusion in order to achieve an activated clotting time ≥ 300 seconds.…”

Pheochromocytoma with the Renovascular Hyperreninemia Attendant on Renal Artery Stenosis

“…Several trials have documented that renal artery stent placement improves or stabilizes renal function in patients with atherosclerotic RAS (749)(750)(751)(752). Significant improvement in renal function up to 1 year after unilateral renal artery stent placement was demonstrated by Leertouwer and coworkers (701).…”

Atherosclerotic Peripheral Vascular Disease Symposium II

“…9 Nonetheless, predictable benefit from renal revascularization may be most pronounced in individuals with renovascular disease that affects the entire renal mass-that is, both kidneys or a solitary kidney. 10 The extent to which renal artery disease affects death rate and renal dysfunction is not well defined. Studies of Medicare beneficiaries starting renal replacement therapy (renal dialysis or transplantation) indicate that 5% to 10% of these individuals have identified renovascular disease.…”