The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease

Abstract

Patients with type 2 diabetes mellitus (T2DM) constitute a large proportion of patients with atherosclerotic renal artery stenosis (ARAS). However, the mechanism of impaired renal function and hypertension in this subset of patients is multifactorial. We aimed to investigate whether, in diabetic patients, renal function (RF), systolic (SBP) and diastolic blood pressure (DBP) values following stent-supported angioplasty (PTA) for ARAS have an impact on cardiovascular and renal outcomes. Methods: The study group included 93 patients with T2DM and resistant hypertension who underwent PTA for ARAS. The pre- and post-procedure (6 to 12, and 24 months) values of SBP, DBP, eGFR and glycaemia were obtained. The prospective follow-up of median 44 months was performed for combined outcome: major cardiac and cerebral events (MACCE) and progression to renal replacement therapy (RRT). Results: MACCE-RRT occurred in 46 (49.5%) patients, with higher incidence in patients with higher values of SBP (147.8 ± 25.8 vs. 136.7 ± 15.8 mmHg, p = 0.006), DBP (80.8 ± 13.3 vs. 74.4 ± 12.3 mmHg, p = 0.009), chronic kidney disease in stages 3B to 5 (p = 0.029) and those who have not obtained target glycemic goals compared to well-maintained T2DM (p = 0.007) at 24-months. On multivariate Cox analysis, well-maintained T2DM targets [Hazard Ratio (HR):0.27; 95% Confidence Interval (CI):0.13–0.57; p < 0.001], eGFR below 45 mL/min/m2 (HR: 2.20; 95%CI: 1.20–4.04; p = 0.011), previous stroke (HR:2.52; 95%CI:1.19–5.34; p = 0.015) retained their associations with MACCE-RRT, while BP values were not associated with the outcome. Conclusions: The post-procedural RF, maintained glycemic target goal and previous stroke are vital for the outcome in patients undergoing PTA for renovascular disease in diabetic patients.

The Relationship between Selected Inflammation and Oxidative Stress Biomarkers and Carotid Intima-Media Thickness (IMT) Value in Youth with Type 1 Diabetes Co-Existing with Early Microvascular Complications

“…In the recent elegant study by Badacz R, the authors aimed to investigate whether, in diabetic patients, the renal function (RF) and systolic (SBP) and diastolic blood pressure (DBP) values following stent-supported angioplasty (PTA) for atherosclerotic renal artery stenosis (ARAS) have an impact on cardiovascular and renal outcomes. In a group of 99 adult patients, they proved, among others, that major cardiac and cerebral events (MACCE) and progression to renal replacement therapy (RRT) were higher among those who did not reach the target glycemic goals compared to well-maintained T2DM at 24 months observation [ 57 ].…”

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review: Part I—Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients

“…Currently, the treatment of choice for RAS is percutaneous transluminal angioplasty (PTA), generally combined with stent implantation, which significantly reduces the incidence of recurrent stenosis and improves long-term outcomes [ 120 , 141 , 146 , 148 , 149 ]. It has a low complication rate of less than 5% in experienced centers and an acceptable stenosis recurrence rate of approximately 15% [ 148 , 149 ].…”

Magnetic Resonance Imaging in Atherosclerotic Renal Artery Stenosis: The Update and Future Directions from Interventional Perspective

“…The above findings have been questioned due to the uneven distribution (few cases with severe stenosis) of patients that excluded patients who could potentially benefit from interventional therapy [11]. Recently, multiple small studies have demonstrated that patients with ARAS who have severe complications, such as resistant hypertension and rapid decline of kidney function, are more likely to benefit from interventional treatment [12][13][14][15]. Therefore, it is a clinical challenge to select patients with potential benefits to assist in the development of clinically optimized treatment options for patients with ARAS (Fig.…”