Percutaneous Revascularization for Atherosclerotic Renal Artery Stenosis: a Meta-analysis

Abstract Objective: This study aimed to investigate whether percutaneous revascularization (PR) was as effective and safe as medication therapy alone in patients with atherosclerotic renal artery stenosis (ARAS).Methods: We searched Embase, PubMed, and the Cochrane Library databases from their inception to July 31, 2021. We included randomized controlled trials (RCTs) reporting PR for ARAS. RevMan 5.3 was employed to conduct the analysis.Results: Of 469 screened studies, 9 were included in our study. A total of 2433 patients with ARAS were recorded. The results demonstrated that PR and medication had a similar antihypertensive effect on both systolic [mean difference (MD)= 0.37, 95% CI: -1.37 to 2.11, p= 0.68] and diastolic blood pressure (MD= -0.75, 95% CI: -2.84 to 1.34, p= 0.48). Meanwhile, there were no differences in all-cause mortality [risk ratio (RR) = 0.90, 95% CI: 0.74-1.10, p=0.31)], stroke (RR = 0.81, 95% CI: 0.53-1.98, p=0.32), congestive heart failure (RR = 0.89, 95% CI: 0.70-1.14, p= 0.36), and periprocedural complications (RR = 0.89, 95% CI: 0.72-1.10, p=0.28).Conclusions: The results revealed that PR was as effective and safe as medication therapy alone in patients with ARAS.

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Percutaneous Revascularization for Atherosclerotic Renal Artery Stenosis: A Meta-Analysis of Randomized Controlled Trials

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.06.062 ◽

2015 ◽

Vol 29 (7) ◽

pp. 1457-1467 ◽

Cited By ~ 8

Author(s):

Yuefeng Zhu ◽

Jun Ren ◽

Xiaobo Ma ◽

Mu-Hsun Chen ◽

Yifan Zhou ◽

...

Keyword(s):

Renal Artery ◽

Randomized Controlled Trials ◽

Renal Artery Stenosis ◽

Meta Analysis ◽

Artery Stenosis ◽

Controlled Trials ◽

Atherosclerotic Renal Artery Stenosis ◽

Randomized Controlled ◽

Percutaneous Revascularization

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Abstract 18388: Albuminuria Determines Event-Free Survival in Atherosclerotic Renal-Artery Stenosis

Circulation ◽

10.1161/circ.130.suppl_2.18388 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Wencan He ◽

Kaleigh L Evans ◽

Kaili Ren ◽

David A Folt ◽

Pamela S Brewster ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Prospective Trial ◽

Composite Endpoint ◽

Roc Curves ◽

Artery Stenosis ◽

Cutoff Point ◽

Glomerular Injury ◽

Atherosclerotic Renal Artery Stenosis ◽

All Cause Mortality

Introduction: Stenosis severity and revascularization may have little relation to outcomes in patients with atherosclerotic renal artery stenosis (ARAS). Albuminuria is a direct indicator of glomerular injury and kidney health. The effect of albuminuria on survival in people with ARAS is not well characterized. Hypothesis: Proteinuria predicts clinical events in people with ARAS. Methods: The Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) clinical trial is a prospective trial of individuals with ARAS. Patients were followed to a maximum of 8 years. Urine albumin and creatinine were measured at a single core lab and the ratio was log transformed (LUACR). The composite endpoint included: cardiovascular (CV) or renal mortality, myocardial infarction (MI), stroke, chronic heart failure (CHF), progressive renal insufficiency (PRI), and renal replacement therapy (RRT). Utilizing receiver operating characteristic (ROC) curves, we developed 3 cutoff points for the LUACR using three methods: Youden’s, closest to the top-left point and the sample median. In order to verify the cutoff point we randomly divided the sample into a training set and a verification set of equal size. Cross verification was applied and the simulation was repeated 5000 times. The analyses are controlled by age, gender, cystatin-c, and systolic blood pressure. Results: Cross verification shows that Youden’s method gives the highest specificity and accuracy. It yields an optimal cutoff point of LUACR=3.83 (UACR is exp(3.83)=46.06). Subjects with values above this threshold, in the verification sample, had higher rates of the composite event rate (50% vs. 27%), PRI (27% vs. 13%), and CHF (16% vs. 5%), all p<0.001; CV death (13% vs. 7%), and all-cause mortality (14% vs. 7%), both p<0.01. Conclusions: Albuminuria powerfully predicts adverse cardiovascular and renal events, including all-cause mortality, in people with ARAS.

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