Renal artery angioplasty and stent placement: Predictors of a favorable outcome

Burket, Mark W.; Cooper, Christopher J.; Kennedy, David J.; Brewster, Pamela; Ansel, Gary M.; Moore, Joseph A.; Venkatesan, J.; Henrich, William L.

doi:10.1016/s0002-8703(00)90310-7

Cited by 124 publications

(82 citation statements)

References 25 publications

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“…Importantly, RAS inhibition and target-driven control of multiple risk factors were feasible, were safe, and produced outcomes for eGFR and clinical events associated with CKD that were not bested by addition of stenting. An earlier collection of reports suggested that renal artery stenting may benefit hypertension, kidney function, and various other clinical outcomes (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Most of these data were derived from observational cohorts (often retrospective), single-center experiences, and uncontrolled or underpowered clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Effects of Stenting for Atherosclerotic Renal Artery Stenosis on eGFR and Predictors of Clinical Events in the CORAL Trial

Tuttle

Dworkin

Henrich

et al. 2016

CJASN

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Background and objectives Atherosclerotic renal artery stenosis may cause kidney function loss, but effects of stenting on eGFR and clinical events associated with CKD are uncertain. Our study objectives were to determine effects of stenting on eGFR and predictors of clinical events.Design, setting, participants, & measurements Participants (n=931) in the Cardiovascular Outcomes in Renal Artery Stenosis Trial (from May of 2005 to September of 2012) had .60% atherosclerotic renal artery stenosis and systolic hypertension on two or more antihypertensive drugs and/or stage $3 CKD. The intervention was stenting versus no stenting on a background of risk factor management: renin-angiotensin system inhibition, statin, antiplatelet therapy, and smoking cessation education. The effect of stenting on eGFR by the serum creatinine-cystatin C Chronic Kidney Disease Epidemiology Collaboration equation was the prespecified analysis of kidney function. Predictors of eGFR and CKD outcomes ($30% eGFR loss, ESRD, and death) and cardiovascular disease outcomes (stroke, myocardial infarction, heart failure, and death) controlling for eGFR and albuminuria were also determined.Results eGFR was 59624 ml/min per 1.73 m 2 (mean6SD) at baseline. Over 3 years, eGFR change, assessed by generalized estimating equations, was 21.567.0 ml/min per 1.73 m 2 per year in the stent group versus 22.366.3 ml/min per 1.73 m 2 per year in the medical therapy only group (P=0.18). eGFR predictors (multiple variable generalized estimating equations) were age, albuminuria, systolic BP, and diabetes (inverse associations) as well as men, total cholesterol, and HDL cholesterol (positive associations). CKD outcomes events occurred in 19% (175 of 931), and predictors (Cox proportional hazards models) included albuminuria (positive association), systolic BP (positive association), and HDL cholesterol (inverse association). Cardiovascular disease outcomes events occurred in 22% (207 of 931), and predictors included age, albuminuria, total cholesterol, prior cardiovascular disease, and bilateral atherosclerotic renal artery stenosis (positive associations).Conclusions Stenting did not influence eGFR in participants with atherosclerotic renal artery stenosis receiving renin-angiotensin system inhibition-based therapy. Predictors of clinical events were traditional risk factors for CKD and cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Effects of Stenting for Atherosclerotic Renal Artery Stenosis on eGFR and Predictors of Clinical Events in the CORAL Trial

Tuttle

Dworkin

Henrich

et al. 2016

CJASN

Self Cite

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“…Long-term patency rates after surgical correction of RAS are probably better than angioplasty 10 . Even better technical results have been shown in patients treated with stents than with angioplasty alone [11][12][13] . The technical success of renal revascularization does not guarantee an improvement in blood pressure control or renal function.…”

Section: Discussionmentioning

confidence: 99%

Índice de resistividade renal como preditor da revascularização renal para hipertensão renovascular

Santos

Leite

Tse³

et al. 2010

Arq. Bras. Cardiol.

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“…Similarly, there is a wealth of uncontrolled study data demonstrating that some patients receive substantial benefits in blood pressure control and renal function. 89,94,98,99 However, renal function worsens in some individuals after revascularization, and blood pressure may not improve. The current controversy is driven by a singular key factor: the lack of an appropriate control group to allow the magnitude of the benefit derived from stenting to be measured.…”

Section: Limitations Of Nonrandomized Evidencementioning

confidence: 99%