Abstract
Background and Aims
Atherosclerotic renal artery stenosis (RAS) is a common disease, associated with significant morbidity and mortality. Several studies have shown that percutaneous angioplasty with stenting (PTA/S) is not superior to medical treatment. The benefit of endovascular intervention among acute kidney injury (AKI) patients requiring hemodialysis secondary to RAS has not been studied. We investigated the effects of PTA/S in patients with atherosclerotic RAS, specifically those who presented with AKI indicated for hemodialysis.
Method
We collected data between 2003 and 2019. We defined a subgroup of patients who presented with AKI and underwent the procedure after starting hemodialysis. Data collected included demographic parameters, medical background, indication for intervention, technical procedure parameters and complications and long term data including dialysis treatment and mortality. Patients who underwent PTA/S due AKI with dialysis were categorized as responders or non-responders based on improvement in kidney function and weaning off dialysis.
Results
We identified 109 PTA/S performed in 92 patients. Technical success was 97% and complication rate was 15.5%. Creatinine and blood pressure improved in 8.9% and 32% respectively, based on predetermined criteria. A subgroup of 11 patients underwent PTA/S for hemodialysis-dependent AKI. 8 patients (73%) improved kidney function and discontinued dialysis. The average time on dialysis was 17 days (range 3-35 days) to PTA/S and 22 days (range 3-42 days) to recovery of kidney function, which occurred 6.5 days (range 1-24 days) after PTA/S. two of the 8 patients required long term hemodialysis after 12 and 22 months post procedure. Only two cases were reported with mild complications (pseudo-aneurysm and brachial hematoma). Factors associated with response to PTA/S include a higher baseline eGFR, less proteinuria, larger kidney size and better contrast enhancement on imaging.
Conclusion
In patients with hemodialysis dependent AKI, PTA/S should be considered as a rescue treatment and may recover kidney function even after prolonged time on dialysis.
Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis
