Renal artery revascularization in patients with atherosclerotic renal artery stenosis and impaired renal function: conservative management versus renal artery stenting.
BACKGROUND
The impact of percutaneous renal artery angioplasty and stenting (PTRAS) for treatment of atherosclerotic renal artery stenosis (ARAS) is not fully understood, especially in patients with chronic kidney disease (CKD). The goal of this study was to compare renal outcomes in patients treated with PTRAS with those managed conservatively.


METHODS
Retrospective cohort study of 118 prevalent patients with significant ARAS and moderate-to-severe CKD who were treated medically (n = 71) or with PTRAS (n = 47). The primary endpoint was change in renal function over the first year after diagnosis/treatment.


RESULTS
Average age was 73 +/- 8 years, baseline glomerular filtration rate was 37 +/- 15 ml/min/1.73 m2, and average follow-up was 34 months. Baseline characteristics were similar between the two groups, with the exception of higher diastolic blood pressure in the PTRAS group (75 versus 70 mmHg, p = 0.028). There were no significant differences between the two groups during follow-up. The decline in glomerular filtration rate was similar in both groups (-1.6 ml/min/1.73 m2 in the medical group versus -1.4 ml/min/1.73 m2 in the PTRAS group, p = 0.938). Multivariate models did not indicate an association between treatment modality and changes in renal function or rates of ESRD or death.


CONCLUSIONS
In patients with advanced kidney disease, medical therapy and renal artery stenting appear comparable in stabilizing renal function for ARAS.
Dichtel
L E
LE
Medical Service, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
Gurevich
Df
D
Rifkin
B
B
Varma
P
P
Concato
J
J
Peixoto
A J
AJ
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D050197:Atherosclerosis / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D007677:Kidney Function Tests; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012078:Renal Artery Obstruction / Q000628:therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome