Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis
- Author:
Suhyun KIM
1
;
Mi Jeoung KIM
;
Jeunseok JEON
;
Hye Ryoun JANG
;
Kwang Bo PARK
;
Wooseong HUH
;
Young Soo DO
;
Yoon Goo KIM
;
Dae Joong KIM
;
Ha Young OH
;
Jung Eun LEE
Author Information
- Publication Type:Randomized Controlled Trial
- Keywords: Angioplasty; Blood pressure; Glomerular filtration rate; Renal artery stenosis
- MeSH: Angioplasty; Blood Pressure; Glomerular Filtration Rate; Humans; Hypertension; Kidney; Pulmonary Edema; Renal Artery Obstruction; Renal Artery; Stents
- From:Kidney Research and Clinical Practice 2019;38(3):336-346
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS. METHODS: From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of ‘kidney function improvement’ or ‘hypertension improvement’ after PTA/S were classified as responders. RESULTS: Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S (P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10–45) mL/min/1.73 m² to 41 (IQR, 16–67) mL/min/1.73 m² at 4 months after PTA/S, although the difference was not significant (P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively (P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150–164) mmHg to 140 (IQR, 131–148) mmHg at 4 months after PTA/S (P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group (P = 0.004). CONCLUSION: PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.
