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A Study on the Outcome of Percutaneous Transluminal Renal Angioplasty in Patients with Renal Failure.

Roussos, Louis LU ; Christensson, Anders LU and Thompson, Olof (2006) In Nephron Clinical Practice 104(3). p.132-142
Abstract
Background: The indications for percutaneous transluminal renal angioplasty (PTRA) in renovascular disease, as well as its benefits, remain a matter of debate. The aim of this study was to evaluate the outcome of angioplasty and to identify risk factors associated with less successful outcomes in patients with atheromatous renal artery stenosis and renal failure of varying degrees. Methods: The results of PTRA were analyzed retrospectively in 144 patients with serum creatinine levels of >130 µmol/l. Patients were divided into 5 groups according to their indication for angioplasty: (1) deteriorating renal function; (2) accelerating hypertension; (3) a combination of 1 and 2; (4) peripheral vascular disease, and (5) miscellaneous... (More)
Background: The indications for percutaneous transluminal renal angioplasty (PTRA) in renovascular disease, as well as its benefits, remain a matter of debate. The aim of this study was to evaluate the outcome of angioplasty and to identify risk factors associated with less successful outcomes in patients with atheromatous renal artery stenosis and renal failure of varying degrees. Methods: The results of PTRA were analyzed retrospectively in 144 patients with serum creatinine levels of >130 µmol/l. Patients were divided into 5 groups according to their indication for angioplasty: (1) deteriorating renal function; (2) accelerating hypertension; (3) a combination of 1 and 2; (4) peripheral vascular disease, and (5) miscellaneous conditions. Results: The baseline mean (± SD) systolic and diastolic blood pressures of the entire group were lowered from 180 ± 32 and 95 ± 16 mm Hg to 162 ± 23 and 86 ± 12 mm Hg, respectively (p < 0.0005), 12 months after angioplasty. The blood pressure level was unaffected by angioplasty in patients with claudication. The mean number of antihypertensive drugs was reduced in the group with accelerating hypertension from 2.9 ± 0.8 to 2.4 ± 1.2 (p = 0.019), and in the group with unilateral renal artery stenosis and two kidneys from 2.4 ± 1.0 to 1.8 ± 1.1 (p = 0.002), 12 months after PTRA. Glomerular filtration rate at 3-month follow-up had increased from 23 ± 11 to 27 ± 14 ml/min/1.73 m2 (p = 0.021) in group 1, from 25 ± 11 to 28 ± 14 ml/min/1.73 m2 (p = 0.031) in the combined group of patients consisting of groups 1 and 3, and from 32 ± 13 to 35 ± 14 ml/min/1.73 m2 (p = 0.019) in the group with unilateral renal artery stenosis. No statistically significant difference was found in any of these 3 groups 1 year after angioplasty. The first patient group had an increased prevalence of cardiovascular disease, aortic aneurysm, carotid occlusive disease, and peripheral vascular disease compared to the other patient groups (p < 0.05). Patients with baseline creatinine levels of >300 µmol/l had a lower survival rate at 12, 60, and 120 months after PTRA than patients with serum creatinine levels of <300 µmol/l (p < 0.005). Survival was also lower in patients with bilateral renal artery stenosis and those with a single kidney, compared to patients with a unilateral stenosis at both 5 and 10 years after PTRA (p < 0.05). Regression analysis of predictor variables of mortality rate showed that the relative risk (RR) associated with increased serum creatinine was 4.7 (CI 2.0-11.0; p < 0.0005). The RR for older patients was 1.1 (CI 1.0-1.2; p = 0.008), and the RR for former smokers was 6.0 (CI 1.6-24.0; p = 0.009). Conclusion: The results of the present study indicate that glomerular filtration can be improved in patients who primarily undergo angioplasty to rescue renal function. Renal function with creatinine levels of >300 µmol/l was associated with a lower survival rate. It is, therefore, possible that patients selected after a thorough evaluation of their renal function and comorbid disease factors may benefit from PTRA, even when the indication for angioplasty is to salvage renal function. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atheromatous renal artery stenosis, accelerating, Comorbid disease risks, Angioplasty, Renal failure, Hypertension
in
Nephron Clinical Practice
volume
104
issue
3
pages
132 - 142
publisher
Karger
external identifiers
  • pmid:16899992
  • wos:000241613900005
  • scopus:33750018297
  • pmid:16899992
ISSN
1660-2110
DOI
10.1159/000094916
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Department of Experimental Medical Science (013210000), Section I-II (013230011), Emergency medicine/Medicine/Surgery (013240200), Medicine (Lund) (013230025)
id
06561def-bf66-4640-9002-225af554542d (old id 160164)
date added to LUP
2016-04-01 11:45:59
date last changed
2019-12-10 02:20:56
@article{06561def-bf66-4640-9002-225af554542d,
  abstract     = {Background: The indications for percutaneous transluminal renal angioplasty (PTRA) in renovascular disease, as well as its benefits, remain a matter of debate. The aim of this study was to evaluate the outcome of angioplasty and to identify risk factors associated with less successful outcomes in patients with atheromatous renal artery stenosis and renal failure of varying degrees. Methods: The results of PTRA were analyzed retrospectively in 144 patients with serum creatinine levels of &gt;130 µmol/l. Patients were divided into 5 groups according to their indication for angioplasty: (1) deteriorating renal function; (2) accelerating hypertension; (3) a combination of 1 and 2; (4) peripheral vascular disease, and (5) miscellaneous conditions. Results: The baseline mean (± SD) systolic and diastolic blood pressures of the entire group were lowered from 180 ± 32 and 95 ± 16 mm Hg to 162 ± 23 and 86 ± 12 mm Hg, respectively (p &lt; 0.0005), 12 months after angioplasty. The blood pressure level was unaffected by angioplasty in patients with claudication. The mean number of antihypertensive drugs was reduced in the group with accelerating hypertension from 2.9 ± 0.8 to 2.4 ± 1.2 (p = 0.019), and in the group with unilateral renal artery stenosis and two kidneys from 2.4 ± 1.0 to 1.8 ± 1.1 (p = 0.002), 12 months after PTRA. Glomerular filtration rate at 3-month follow-up had increased from 23 ± 11 to 27 ± 14 ml/min/1.73 m2 (p = 0.021) in group 1, from 25 ± 11 to 28 ± 14 ml/min/1.73 m2 (p = 0.031) in the combined group of patients consisting of groups 1 and 3, and from 32 ± 13 to 35 ± 14 ml/min/1.73 m2 (p = 0.019) in the group with unilateral renal artery stenosis. No statistically significant difference was found in any of these 3 groups 1 year after angioplasty. The first patient group had an increased prevalence of cardiovascular disease, aortic aneurysm, carotid occlusive disease, and peripheral vascular disease compared to the other patient groups (p &lt; 0.05). Patients with baseline creatinine levels of &gt;300 µmol/l had a lower survival rate at 12, 60, and 120 months after PTRA than patients with serum creatinine levels of &lt;300 µmol/l (p &lt; 0.005). Survival was also lower in patients with bilateral renal artery stenosis and those with a single kidney, compared to patients with a unilateral stenosis at both 5 and 10 years after PTRA (p &lt; 0.05). Regression analysis of predictor variables of mortality rate showed that the relative risk (RR) associated with increased serum creatinine was 4.7 (CI 2.0-11.0; p &lt; 0.0005). The RR for older patients was 1.1 (CI 1.0-1.2; p = 0.008), and the RR for former smokers was 6.0 (CI 1.6-24.0; p = 0.009). Conclusion: The results of the present study indicate that glomerular filtration can be improved in patients who primarily undergo angioplasty to rescue renal function. Renal function with creatinine levels of &gt;300 µmol/l was associated with a lower survival rate. It is, therefore, possible that patients selected after a thorough evaluation of their renal function and comorbid disease factors may benefit from PTRA, even when the indication for angioplasty is to salvage renal function.},
  author       = {Roussos, Louis and Christensson, Anders and Thompson, Olof},
  issn         = {1660-2110},
  language     = {eng},
  number       = {3},
  pages        = {132--142},
  publisher    = {Karger},
  series       = {Nephron Clinical Practice},
  title        = {A Study on the Outcome of Percutaneous Transluminal Renal Angioplasty in Patients with Renal Failure.},
  url          = {http://dx.doi.org/10.1159/000094916},
  doi          = {10.1159/000094916},
  volume       = {104},
  year         = {2006},
}