Renal insufficiency as a predictor of adverse events and mortality after renal artery stent placement

Kennedy, David J.; Colyer, William R.; Brewster, Pamela; Ankenbrandt, Mary; Burket, Mark W.; Németh, Attila; Khuder, Sadik A.; Thomas, William J.; Shapiro, Joseph I.; Cooper, Christopher J.

doi:10.1016/j.ajkd.2003.06.004

Cited by 96 publications

(55 citation statements)

References 45 publications

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“…Few would disagree with the contention that improvement in GFR reflected by a fall of serum creatinine of 4.5 to 2.2 mg/dl is a major benefit and obviates the imminent need for renal replacement therapy in many cases, as has been again emphasized (6). A recent series of 261 patients who underwent renal artery stenting also demonstrated reduced mortality from cardiovascular events in subsequent years in the subgroup whose final estimated GFR was Ͼ40 ml/min (19). The benefits of revascularization for such a subgroup are reflected in other recent series, particularly those with RAS affecting the entire renal mass (57).…”

Section: When To Pursue Renal Revascularization For Ischemic Nephropathymentioning

confidence: 99%

“…(2) The presence of RAS predicts subsequent mortality, regardless of whether renal revascularization is pursued (18). Mortality in patients with renovascular disease is related to cardiovascular events, including myocardial infarction, stroke, congestive heart failure, etc (19). (3) Although progression of renal arterial disease leading to either total occlusion and/or irreversible renal injury can occur, the benefits of vascular repair must be considered in the context of other comorbid disease.…”

Section: Epidemiology Of Atherosclerotic Renal Artery Diseasementioning

confidence: 99%

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Ischemic Nephropathy

Textor

2004

Journal of the American Society of Nephrology

148

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Abstract. Identification and reversing the loss of kidney function beyond occlusive disease of the renal arteries poses a major clinical challenge. Recent studies indicate that atherosclerotic renal artery stenosis develops as a function of age and is commonly associated with other microvascular disease, including nephrosclerosis and diabetic nephropathy. The risks of renal artery stenosis are related both to declining kidney function and to accelerated cardiovascular disease, with increased morbidity and mortality. Newer drugs, including agents that block the renin-angiotensin system, have improved the level of BP control for renovascular hypertension. Progressive renovascular disease during medical therapy can produce refractory hypertension, congestive heart failure, and renal failure with tubulointerstitial fibrosis. Recent studies indicate a complex interplay of oxidative stress, endothelial dysfunction, and activation of fibrogenic cytokines as a result of experimental atherosclerosis and renal hypoperfusion. Advances in imaging and interventional devices offer major new opportunities to prevent progressive loss of kidney function. Recent series indicate that although 25 to 30% of patients with impaired renal function can recover glomerular filtration after revascularization, many have no apparent change in kidney function and 19 to 25% experience a significant loss of kidney function, in some cases as a result of atheroemboli. To select patients who are most likely to benefit from vascular intervention, clinicians should understand the pathophysiology of developing ischemic nephropathy and the potential hazards of revascularization in the setting of diffuse atherosclerotic disease. Further research should be directed toward identification of critical disease, regulation of fibrogenesis, and the interaction with other atherosclerotic processes.

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Section: When To Pursue Renal Revascularization For Ischemic Nephropathymentioning

confidence: 99%

Section: Epidemiology Of Atherosclerotic Renal Artery Diseasementioning

confidence: 99%

Ischemic Nephropathy

Textor

2004

Journal of the American Society of Nephrology

148

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“…Five-year patency following aortorenal bypass is 95.0%, compared to 55.6% for renal artery stenting. 7,10,[18][19][20] The five-year patency was assumed to be similar between patients who had no complications and those who experienced one or more complications. A primary patency of 75% was identified in the literature and used for aortorenal bypass patients who developed complications to determine whether this significantly influenced cost or value for aortorenal bypass compared to renal artery stenting, but none was found (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Dua

Desai²,

Upchurch

et al. 2015

Vascular

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Introduction: This study compared aortorenal bypass to renal artery stenting to determine the most efficacious and financially sound method for treating patients with atherosclerotic renal artery stenosis (RAS). Methods: A decision analysis using direct and indirect costs, and value of statistical life (VSL) was completed. Direct costs were obtained using the Nationwide Inpatient Sample (NIS), indirect costs from the National Institute of Diabetes and Digestive and Kidney Diseases, and VSL from the Department of Transportation. A variance-based sensitivity analysis was completed to assess the accuracy of the decision analysis. Results: Aortorenal bypass has a 95% five-year patency, a 98% 30-day survival, a 26% rate of overall complications, and a 70% five-year dialysis-free survival. Renal artery stenting has a 56% five-year patency, a 99% 30-day survival, a 40% rate of complications, and a 65% five-year dialysis-free survival. Renal artery stenting has an overall cost of $305,370 and aortorenal bypass has an overall cost of $103,453 per patient. After accounting for VSL, renal artery stenting has a negative value of À$182,270 and aortorenal bypass has a value of $415,881. Conclusions: Lower five-year patency and higher rate of complications from renal artery stenting that ultimately lead to significantly lower five-year dialysis-free survival.

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“…ARAS has also been associated with left ventricular dysfunction and congestive heart failure [14,15]. Conversely, improvement in renal function in patients with ARAS following PTRA has been reported to improve survival as well as quality of life [16][17][18].…”

Section: Atherosclerotic Renal Artery Stenosis and Cardiovascular Outmentioning

confidence: 99%