Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease

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• 作者：Sanjay Misra ; MD^a ; ^{misra.sanjay@mayo.edu" class="auth_mail" title="E-mail the corresponding author} ; Ankaj Khosla ; MD^a ; Jake Allred ; MS^a ; William S. Harmsen ; MS^a ; Stephen C. Textor ; MD^b ; Michael A. McKusick ; MD^c
• 关键词：ACEI ; angiotensin-converting enzyme inhibitor ; ARB ; angiotensin receptor blocker ; ASTRAL ; Angioplasty and STent for Renal Artery Lesions ; CI ; confidence interval ; CKD ; chronic kidney disease ; CORAL ; Cardiovascular Outcomes in Renal Atherosclerotic Lesions ; GFR ; glomerular filtration rate ; HR ; hazard ratio ; RA ; renal artery ; RAS ; renal artery stenosis ; RRT ; renal replacement therapy ; STAR ; Stenting in Renal Dysfunction Caused by Atherosclerotic Renal Artery Stenosis ; USRDS ; United States Renal Da
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：27
• 期：8
• 页码：1215-1224
• 全文大小：391 K

文摘

To identify risk factors for progression to renal replacement therapy (RRT) and all-cause mortality in patients who underwent renal artery (RA) stent placement for atherosclerotic renal artery stenosis (RAS).

Materials and Methods

A retrospective study from June 1996 to June 2009 identified 1,052 patients who underwent RA stent placement. Glomerular filtration rate at time of RA stent placement was estimated from serum creatinine level and divided into chronic kidney disease (CKD) stages 1–5. Univariate and multivariable Cox proportional hazards models were used to determine which factors were associated with each endpoint.

Results

Times to progression to all-cause mortality and RRT were similar for CKD stages 1/2/3A and served as the reference group. In multivariable analysis, high-grade proteinuria (P < .001) and higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P < .001], 3B vs 1/2/3A [P = .02]) remained independently associated with increased risk of progression to RRT. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use was associated with decreased risk of progression to RRT (P = .03). Higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P = .004]), carotid artery disease (P < .001), diabetes mellitus (P = .002), and high-grade proteinuria (P < .001) remained independently associated with all-cause mortality. Statin use was associated with decreased risk of all-cause mortality (P < .001).

Conclusions

Patients with atherosclerotic RAS who undergo RA stent placement and have high-grade proteinuria and CKD stage 3B/4/5 have increased risk of progression to RRT. Patients with high-grade proteinuria, CKD stage 3B/4/5, carotid artery disease, or diabetes have increased risk for all-cause mortality after renal artery stent placement. Patients receiving ACEI/ARBs have a decreased risk of progression to RRT, and patients receiving statins have a decreased risk of all-cause mortality.