Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis

다국어 초록 (Multilingual 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 highrisk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.

참고문헌 (Reference)

1 UK Medicines Information, "What are appropriate doses to use when switching hypertensive patients to amlodipine from lercanidipine or lacidipine?" Surrey and Sussex Healthcare NHS Trust

2 Levy PD, "Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction" 10 : 906-916, 2016

3 Mohan IV, "The management of renal artery stenosis : an alternative interpretation of ASTRAL and CORAL" 49 : 465-473, 2015

4 Vassallo D, "The effect of revascularization in patients with anatomically significant atherosclerotic renovascular disease presenting with high-risk clinical features" 33 : 497-506, 2018

5 Cooper CJ, "Stenting and medical therapy for atherosclerotic renal-artery stenosis" 370 : 13-22, 2014

6 ASTRAL Investigators, "Revascularization versus medical therapy for renal-artery stenosis" 361 : 1953-1962, 2009

7 Ram CV, "Renovascular hypertension" 6 : 575-579, 1997

8 Ma Z, "Renal artery stent in solitary functioning kidneys: 77% of benefit: a systematic review with meta-analysis" 95 : e4780-, 2016

9 Derkx FH, "Renal artery stenosis and hypertension" 344 : 237-239, 1994

10 Hemmelgarn BR, "Relation between kidney function, proteinuria, and adverse outcomes" 303 : 423-429, 2010

11 Kądziela J, "Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting(PREFER study)" 20 : 418-422, 2013

12 Leesar MA, "Prediction of hypertension improvement after stenting of renal artery stenosis : comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography" 53 : 2363-2371, 2009

13 Mitchell JA, "Predicting blood pressure improvement in hypertensive patients after renal artery stent placement : renal fractional flow reserve" 69 : 685-689, 2007

14 Ritchie J, "High-risk clinical presentations in atherosclerotic renovascular disease : prognosis and response to renal artery revascularization" 63 : 186-197, 2014

15 Inker LA, "Estimating glomerular filtration rate from serum creatinine and cystatin C" 367 : 20-29, 2012

16 Evridiki Karanikola, "Endovascular Management of Atherosclerotic Renal Artery Stenosis: Post-Cardiovascular Outcomes in Renal Atherosclerotic Lesions Era Winner or False Alarm?" 대한혈관외과학회 33 (33): 1-15, 2017

17 "Drug comparisons - beta blockers equivalent doses" GlobalRPh Inc

18 "Dihydropyridine calcium channel blocker interchange" Vancouver Acute

19 Manolis AS, "Current status of renal artery angioplasty and stenting for resistant hypertension : a case series and review of the literature" 13 : 93-103, 2017

20 Harada K, "Comparison of the antagonistic activity of tamsulosin and doxazosin at vascular alpha 1-adrenoceptors in humans" 354 : 557-561, 1996

21 "Comparison of angiotensin converting enzyme (ACE) inhibitors" Vancouver Acute

22 Kumbhani DJ, "Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis : a meta-analysis of randomized controlled trials" 161 : 622.e1-630.e1, 2011

23 Fujihara M, "Clinical outcome of renal artery stenting for hypertension and chronic kidney disease up to 12 months in the J-RAS Study-prospective, single-arm, multicenter clinical study" 79 : 351-359, 2015

24 Jenks S, "Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis" (12) : CD002944-, 2014

25 Rossetti G, "Antihypertensive effect of barnidipine 10 mg or amlodipine 5 to 10 mg once daily in treatment-naive patients with essential hypertension : A 24-week, randomized, open-label, pilot study" 69 : 192-206, 2008

26 "Angiotensin II receptor blockers" GlobalRPh Inc

27 Gerstein HC, "Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals" 286 : 421-426, 2001

28 Hirsch AT, "ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)--summary of recommendations" 17 : 1383-1397, 2006

29 Mancia G, "2013 ESH/ESC guidelines for the management of arterial hypertension : the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)" 34 : 2159-2219, 2013