Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis.
BACKGROUND
Percutaneous stent-supported angioplasty is a treatment option for atherosclerotic ostial renal artery stenosis. Improvement of renal function by such intervention, however, is controversial and thought to be limited to specific subsets, such as nondiabetic patients and bilateral stenoses. In this prospective study, we investigated predictors for improvement of renal function and blood pressure after renal artery stent placement.


RESULTS
The study included 215 consecutive patients with ostial renal artery stenosis of > or =70% diameter stenosis undergoing stent-supported angioplasty. The primary end point was decrease in serum creatinine concentration at 1 year; the secondary end point, decrease in average mean arterial blood pressure assessed by 24-hour monitoring. One-year follow-up was complete in 191 surviving patients. In 52% (99/191) of the patients, serum creatinine concentration decreased during 1-year follow-up. Median serum creatinine concentration dropped significantly from 1.21 mg/dL (quartiles: 0.92, 1.60 mg/dL) at baseline to 1.10 mg/dL (quartiles: 0.88, 1.50 mg/dL) at 1 year (P=0.047). On average, mean arterial blood pressure decreased significantly, from 102+/-12 mm Hg (mean+/-SD) at baseline to 92+/-10 mm Hg at 1 year (P<0.001). Significant independent predictors of improved renal function were baseline serum creatinine (odds ratio [95% CI], 2.58 [1.35 to 4.94], P=0.004) and left ventricular function (OR 1.51 [1.04 to 2.21], P=0.032). Female sex, high baseline mean blood pressure, and normal renal parenchymal thickness were independent predictors for decreased mean blood pressure.


CONCLUSIONS
Stent-supported angioplasty for severe ostial renal artery stenosis improves renal function and blood pressure in a broader spectrum of patients than previously thought.
Zeller
Thomas
T
Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
Frank
Ulrich
U
Müller
Christian
C
Bürgelin
Karlheinz
K
Sinn
Lutz
L
Bestehorn
Hans-Peter
HP
Cook-Bruns
Nancy
N
Neumann
Franz-Josef
FJ
D000368:Aged; D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000150:complications* / Q000473:pathology; D001794:Blood Pressure; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012077:Renal Artery / Q000473:pathology / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012737:Sex Factors; D015607:Stents; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D003404:Creatinine