Renal artery stenting slows the rate of renal function decline.
OBJECTIVE
The primary objective of this study was to analyze renal artery interventions performed at a tertiary medical center and to evaluate improvements in hypertension and renal excretory function.


METHODS
A retrospective analysis was performed of patients treated at a tertiary medical center from January 2001 to December 2005. All patients treated with renal artery stenting by the Interventional Radiology or Endovascular Services were included. Descriptive and inferential analyses were performed.


RESULTS
Forty patients with renal artery stenosis were evaluated for renal artery stenting, of these 22 were followed up with medical management. Twenty-six renal artery stents were placed in 18 patients (mean age, 70 +/- 8 years), of whom 76% were treated for multidrug resistant hypertension, and 24% were treated for renal salvage. Mean follow-up was 15 months. Patients experienced a significant reduction in hypertension and in the number of antihypertensive agents, but this significance deteriorated at 6 months, when their blood pressure and number of medications returned to preprocedural values. Compared with a cohort that was followed up with medical management, the rate of renal function decline improved from -0.08 mg/dL per month to 0.00 mg/dL per month (P < .05) after intervention. Patients with baseline chronic renal insufficiency experienced the greatest benefit from renal artery stenting.


CONCLUSIONS
Renal artery stenting initially improves hypertension control, but the durability is lost after 6 months. Renal artery stenting dramatically slows the rate of renal function decline and could potentially delay a patient's requirement for hemodialysis.
Arthurs
Zachary
Z
Department of Surgery, Madigan Army Medical Center, Tacoma, Wash., USA. arthursz@mac.com <arthursz@mac.com>
Starnes
Benjamin
B
Cuadrado
Daniel
D
Sohn
Vance
V
Cushner
Howard
H
Andersen
Charles
C
D000368:Aged; D017130:Angioplasty; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D007677:Kidney Function Tests; D016017:Odds Ratio; D018579:Patient Selection; D016016:Proportional Hazards Models; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000097:blood / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D000959:Antihypertensive Agents; D003404:Creatinine