TY - JOUR
T1 - Atherosclerotic Renovascular Disease
T2 - A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference
AU - Hicks, Caitlin W.
AU - Clark, Timothy W.I.
AU - Cooper, Christopher J.
AU - de Bhailís, Áine M.
AU - De Carlo, Marco
AU - Green, Darren
AU - Małyszko, Jolanta
AU - Miglinas, Marius
AU - Textor, Stephen C.
AU - Herzog, Charles A.
AU - Johansen, Kirsten L.
AU - Reinecke, Holger
AU - Kalra, Philip A.
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2022/2
Y1 - 2022/2
N2 - The diagnosis and management of atherosclerotic renovascular disease (ARVD) is complex and controversial. Despite evidence from the ASTRAL (2009) and CORAL (2013) randomized controlled trials showing that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone over 3-5 years, several areas of uncertainty remain. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin-aldosterone system blockers is now considered the primary means to treat hypertension in the setting of ARVD. However, the criteria to identify kidneys with renal artery stenosis that have potentially salvageable function are evolving. There are also data suggesting that certain high-risk populations with specific clinical manifestations may benefit from revascularization. Here, we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.
AB - The diagnosis and management of atherosclerotic renovascular disease (ARVD) is complex and controversial. Despite evidence from the ASTRAL (2009) and CORAL (2013) randomized controlled trials showing that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone over 3-5 years, several areas of uncertainty remain. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin-aldosterone system blockers is now considered the primary means to treat hypertension in the setting of ARVD. However, the criteria to identify kidneys with renal artery stenosis that have potentially salvageable function are evolving. There are also data suggesting that certain high-risk populations with specific clinical manifestations may benefit from revascularization. Here, we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.
KW - Atherosclerotic renovascular disease (ARVD)
KW - RAAS blockade
KW - blood pressure control
KW - chronic kidney disease (CKD)
KW - fibromuscular dysplasia (FMD)
KW - heart failure (HF)
KW - ischemic nephropathy
KW - renal artery stenosis (RAS)
KW - renin-angiotensin-aldosterone system (RAAS)
KW - revascularization
KW - treatment recommendations
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U2 - 10.1053/j.ajkd.2021.06.025
DO - 10.1053/j.ajkd.2021.06.025
M3 - Article
C2 - 34384806
AN - SCOPUS:85117916321
SN - 0272-6386
VL - 79
SP - 289
EP - 301
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -