title: Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review.
abstract: BACKGROUND
  Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death.
  
  
  OBJECTIVE
  To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS.
  
  
  METHODS
  MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews.
  
  
  METHODS
  Randomized, controlled trials (RCTs); nonrandomized, comparative studies (NRCSs); single-group studies; and selected case reports that reported all-cause and cardiovascular mortality, RRT, kidney function, BP, and adverse events.
  
  
  METHODS
  Six researchers extracted data on design, interventions, outcomes, and study quality into a Web-based database.
  
  
  RESULTS
  Eighty-three studies met eligibility criteria. In 5 of 7 RCTs, PTRAS and medical therapy led to similar BP control in patients with ARAS, and no RCTs showed statistically significant differences in kidney function, mortality, RRT, cardiovascular events, or pulmonary edema. Eight NRCSs had more variable results, finding mostly no significant differences in mortality, RRT, or cardiovascular events but heterogeneous effects on kidney function and BP. Procedure-related adverse events were rare, and medication-related adverse events were not reported. Two RCTs found no patient characteristics that were associated with outcomes with either PTRAS or medical therapy. Single-group studies found various but inconsistent factors that predict outcomes. Case reports provided examples of clinical improvement after PTRAS in patients with acute decompensation.
  
  
  CONCLUSIONS
  Limited clinical applicability and power in RCTs, and possible publication bias and lack of adjusted analyses in NRCSs.
  
  
  CONCLUSIONS
  The strength of evidence regarding the relative benefits and harms of PTRAS versus medical therapy alone for patients with ARAS is low. Studies have generally focused on patients with less severe ARAS.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Gowri
authors.initials: G
authors.lastname: Raman
authors.affiliation: From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Gaelen P
authors.initials: GP
authors.lastname: Adam
authors.affiliation: From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Halladay
authors.affiliation: From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Valerie N
authors.initials: VN
authors.lastname: Langberg
authors.affiliation: From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Ijeoma A
authors.initials: IA
authors.lastname: Azodo
authors.affiliation: From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Balk
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods; D000959:Antihypertensive Agents / Q000627:therapeutic use; D057186:Comparative Effectiveness Research; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D012078:Renal Artery Obstruction / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D015607:Stents
chemical_list: D000959:Antihypertensive Agents