Association between renal function and outcomes after percutaneous transluminal renal angioplasty in hypertensive patients with renal artery stenosis
We investigated the impact of renal function on outcomes after percutaneous transluminal angioplasty.Methods:
A total of 139 hypertensive patients with atherosclerotic renal artery stenosis (mean age, 70 years, 80.6% men) who underwent renal percutaneous transluminal angioplasty were included. Renal function was evaluated on the basis of estimated glomerular filtration rate (eGFR) and albuminuria/proteinuria, and classified into three categories according to eGFR (≥45, 30–44, and <30 ml/min/1.73 m2) and albuminuria/proteinuria [normal-to-mild: albumin/creatinine ratio (ACR) less than 3.0, protein/creatinine ratio (PCR) less than 15; moderate: ACR 3.0–30.0, PCR 15–50; severe: ACR > 30.0, PCR > 50 mg/mmol].Results:
During a median follow-up of 5.4 years, 36.0% of patients developed the primary composite end point, including cardiovascular and renal outcomes. In multivariate Cox regression analysis, eGFR less than 30 (hazard ratio 3.47, P < 0.01) as well as severe albuminuria/proteinuria (hazard ratio 2.63, P < 0.05) was an independent predictor of worse outcome. In the subgroup without events within 1 year after angioplasty (n = 117), the outcome differed among the three renal functional categories at 1 year based on eGFR (log-rank χ2 = 16.28, P < 0.001) as well as on albuminuria/proteinuria (log-rank χ2 = 8.30, P < 0.05). At 1 year, 24 patients (20.1%) showed at least 20% decrease in eGFR, and their outcome was worse than that in those with at least 20% increase (n = 23) (hazard ratio 3.50, P < 0.05). Multiple logistic regression analysis indicated that pretreatment moderate-to-severe albuminuria/proteinuria was an independent predictor of at least 20% eGFR decrease (odds ratio 2.82, P < 0.05).Conclusion:
Impaired renal function, and in particular, a poor response of eGFR to angioplasty, is associated with worse outcome. Therapeutic effectiveness of renal angioplasty seems to be limited in patients with albuminuria/proteinuria.