Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

Abstract

Background/Aims: Clinical benefits of percutaneous treatment of renal artery stenosis (RAS) remain controversial. The aim of this study was to evaluate the effects of renal artery stenting on kidney function and blood pressure (BP) control in the log-term follow-up. Additionally angiographic follow up was performed in selected subgroup of patients. Methods: The study was designed as international registry of 265 consecutive patients with RAS treated with renal artery stenting. The primary end-point of the study was the change in renal function and blood pressure at long-term follow-up as compared with baseline values. Evaluation of the renal function was based on estimated glomerular filtration rate (eGFR) with the use of the modification of diet in renal disease (MDRD) formula. Results: All patients had clinical follow-up at the median time of 23.8 (interquartile range: 3-90) months during ambulatory visits. At follow-up eGFR improved in 53,9% of patients. These patients had lower preprocedural systolic BP, more severe lesion type at baseline and lower diameter stenosis in control angiography. At follow up visits, SBP improvement was observed in 77,4% of patients. The average number of anti-hypertensive medications before the procedure and at follow up did not change significantly (2,70±1,0 vs 2,49±0,9, p=0,1). Restenosis rate based on control angiography performed at median time of 15 months was 12%. Conclusion: The results of the

Pulse Pressure, Instead of Brachium-Ankle Pulse Wave Velocity, is Associated with Reduced Kidney Function in a Chinese Han Population

“…Since glomerular filtration rate (GFR) is difficult to measure, GFR is calculated from the serum concentrations of endogenous filtration markers, which is called estimated glomerular filtration rate (eGFR) [14-16]. As a surrogate parameter for renal function, eGFR has been widely used in the diagnosis and clinical management of CKD [14-25]. To date, studies on the relationship between PWV and renal function have yielded inconsistent results [17-24].…”

Impact of Renal Function Trajectory on Renal Replacement Therapy and Mortality Risk after Renal Artery Revascularization

“…Renal function may improve in approximately half of patients who undergo renal artery revascularization, whereas approximately one third may experience progression of kidney disease (13). Patients with lower baseline eGFR or rapidly declining kidney function may show a greater response to stent placement than patients with normal or near-normal kidney function, as seen in previous randomized control trials (11,14,15). Rates of progression to RRT after renal stent placement have been reported to be approximately 10%-20% among patients with CKD (16,17).…”

“…The findings in the present study indicate that, for patients with advanced CKD, the risk for RRT and all-cause mortality will decrease with each unit of eGFR increase. Patients with renal insufficiency from renal artery stenosis and intact compensatory mechanisms such as sustained hypertension may benefit more from revascularization (11). This may explain the lack of benefit from renal artery stent placement demonstrated in the CORAL trial (4), in which patients had better baseline kidney function as well as questionable anatomic and no hemodynamic assessment of the significance of renal artery stenosis (12).…”

Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis

“…Previous retrospective and prospective observational studies reported the benefits of renal artery revascularization in terms of blood pressure decrease and renal protection in patients with ARAS ≥50% [26, 27] even when this was associated with uncontrolled hypertension [28-30]. In a registry of 265 patients with angiographic evidence of ARAS ≥50%, a subgroup of whom had uncontrolled systolic hypertension, average blood pressure fell in a follow-up of 2 years from 160/86 mm Hg to 135/75 mm Hg [28].…”

“…In a registry of 265 patients with angiographic evidence of ARAS ≥50%, a subgroup of whom had uncontrolled systolic hypertension, average blood pressure fell in a follow-up of 2 years from 160/86 mm Hg to 135/75 mm Hg [28]. Approximately half of patients in the registry had improved glomerular filtration suggesting that renal revascularization could preserve renal function in a substantial proportion.…”