title: Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis.
abstract: 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.
authors.affiliation: Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frank
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Bürgelin
authors.forename: Lutz
authors.initials: L
authors.lastname: Sinn
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bestehorn
authors.forename: Nancy
authors.initials: N
authors.lastname: Cook-Bruns
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: 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
chemical_list: D003404:Creatinine