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

Sanjay Misra, Ankaj Khosla, Jake Allred, William S. Harmsen, Stephen C Textor, Michael A. McKusick

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1215-1224
Number of pages10
JournalJournal of Vascular and Interventional Radiology
Volume27
Issue number8
DOIs
StatePublished - Aug 1 2016

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Renal Replacement Therapy
Renal Artery
Stents
Chronic Renal Insufficiency
Mortality
Proteinuria
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Renal Artery Obstruction
Carotid Artery Diseases
Angiotensin Receptor Antagonists
Glomerular Filtration Rate
Proportional Hazards Models
Angiotensin-Converting Enzyme Inhibitors
Creatinine
Diabetes Mellitus
Retrospective Studies
Serum

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease. / Misra, Sanjay; Khosla, Ankaj; Allred, Jake; Harmsen, William S.; Textor, Stephen C; McKusick, Michael A.

In: Journal of Vascular and Interventional Radiology, Vol. 27, No. 8, 01.08.2016, p. 1215-1224.

Research output: Contribution to journalArticle

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title = "Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease",
abstract = "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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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.

PY - 2016/8/1

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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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