Predictors of clinical outcome after stent placement in atherosclerotic renal artery stenosis: a systematic review and meta-analysis of prospective studies.
OBJECTIVE
To determine clinical predictors for blood pressure and/or renal function improvement after renal artery stent placement in atherosclerotic renal artery stenosis (ARAS).


METHODS
We searched PubMed, EMBASE and Cochrane databases for prospective studies investigating clinical predictive variables for renal function and/or blood pressure improvement after stent placement in ARAS. Eleven studies (1552 participants) were selected for our systematic review and meta-analysis. Meta-regression analysis was performed to investigate heterogeneity and to determine independent predictors for the outcome variables. Bias was evaluated by use of the Cochrane risk of bias tool.


RESULTS
Multivariate meta-regression analysis showed no predictors for renal function improvement. High baseline diastolic blood pressure (DBP) and pulse pressure were significantly associated with the decrease in blood pressure after intervention. These results were consistent with the predictors reported by the individual studies. Meta-analysis showed a nonsignificant decline in serum creatinine of 4.7 μmol/l [95% confidence interval (Cl) -13.8 to 4.5]. Overall, systolic blood pressure (SBP) fell by 19.2 mmHg (95% Cl -22.7 to -15.7) and DBP decreased 8.9 mmHg (95% Cl -10.8 to -7.0). Risk of bias was present in the majority of the studies.


CONCLUSIONS
The present review did not find a clinical characteristic that reliably predicts renal function outcome. High baseline pulse pressure predicted a smaller decrease in SBP after intervention and the best clinical predictor for a larger DBP reduction was a high pretreatment DBP.
Ronden
Rianne A
RA
Department of Internal Medicine, Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands.
Houben
Alfons J
AJ
Kessels
Alfons G
AG
Stehouwer
Coen D
CD
de Leeuw
Peter W
PW
Kroon
Abraham A
AA
D050197:Atherosclerosis / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D006801:Humans; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome
D003404:Creatinine