title: Clinical and kidney morphologic predictors of outcome for renal artery stenting: data to inform patient selection.
abstract: BACKGROUND
  The purpose of the current study was to identify clinical and kidney morphologic features that predict a favorable blood pressure (BP) response to renal artery stenting (RAS).
  
  
  METHODS
  The study cohort consisted of 149 patients who underwent primary RAS over 9 years. Patients were categorized as "responders" based on modified American Heart Association guidelines: BP <160/90 mm Hg on fewer antihypertensive medications or diastolic BP <90 mm Hg on the same medications. All other patients were deemed "nonresponders." Renal volume was estimated as kidney length × width × depth/2 based on preoperative computed tomography or magnetic resonance scans. Median follow-up was 19 months (interquartile range [IQR] 10.0-29.5 months).
  
  
  RESULTS
  The median age of the cohort was 68 years (IQR, 60-74 years). A favorable BP response was observed in 50 of 149 patients (34%). Multivariate analysis identified three independent predictors of a positive BP response: (1) requirement for four or more medications (odds ratio, 29.9; P = .0001), (2) preoperative diastolic BP >90 mm Hg (OR, 31.4; P = .0011), and (3) preoperative clonidine use (OR, 7.3; P = .029). The BP response rate varied significantly based on the number of predictors present per patient (P < .0001). Among patients with three-drug hypertension, a larger ipsilateral kidney (volume ≥150 cm(3)) increased the BP response rate more than threefold compared with patients with smaller kidneys (63% vs 18% BP response rate; P = .018).
  
  
  CONCLUSIONS
  The current study demonstrated that three clinical predictors (≥4 antihypertensive medications, diastolic BP ≥90 mm Hg, and clonidine use) are preoperative predictors of BP response to RAS. Kidney volume may help in discriminating responders from nonresponders among those patients with three-drug hypertension. These parameters may assist clinicians in patient selection and provide more concrete data with which to counsel patients on the likely outcomes for RAS.
authors.affiliation: Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA. greg.modrall@utsouthwestern.edu
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Modrall
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rosero
authors.forename: David
authors.initials: D
authors.lastname: Leonard
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
authors.forename: Thomas
authors.initials: T
authors.lastname: Anthony
authors.forename: Frank A
authors.initials: FA
authors.lastname: Arko
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
authors.forename: Clayton
authors.initials: C
authors.lastname: Trimmer
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003000:Clonidine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009929:Organ Size; D018579:Patient Selection; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D013781:Texas; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D003000:Clonidine