TY - JOUR
T1 - Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease
AU - Misra, Sanjay
AU - Khosla, Ankaj
AU - Allred, Jake
AU - Harmsen, William S.
AU - Textor, Stephen C.
AU - McKusick, Michael A.
N1 - Funding Information:
This work was funded by National Institutes of Health Grant HL098967 (S.M.) from the National Heart, Lung, and Blood Institute. A.K. has received a Medical Student grant from the Society of Interventional Radiology Foundation.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Purpose 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.
AB - Purpose 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.
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U2 - 10.1016/j.jvir.2016.05.001
DO - 10.1016/j.jvir.2016.05.001
M3 - Article
C2 - 27296703
AN - SCOPUS:84990932699
VL - 27
SP - 1215
EP - 1224
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
SN - 1051-0443
IS - 8
ER -