Document Detail


Clinical and kidney morphologic predictors of outcome for renal artery stenting: data to inform patient selection.
MedLine Citation:
PMID:  21316901     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of the current study was to identify clinical and kidney morphologic features that predict a favorable blood pressure (BP) response to renal artery stenting (RAS).
METHODS: The study cohort consisted of 149 patients who underwent primary RAS over 9 years. Patients were categorized as "responders" based on modified American Heart Association guidelines: BP <160/90 mm Hg on fewer antihypertensive medications or diastolic BP <90 mm Hg on the same medications. All other patients were deemed "nonresponders." Renal volume was estimated as kidney length × width × depth/2 based on preoperative computed tomography or magnetic resonance scans. Median follow-up was 19 months (interquartile range [IQR] 10.0-29.5 months).
RESULTS: The median age of the cohort was 68 years (IQR, 60-74 years). A favorable BP response was observed in 50 of 149 patients (34%). Multivariate analysis identified three independent predictors of a positive BP response: (1) requirement for four or more medications (odds ratio, 29.9; P = .0001), (2) preoperative diastolic BP >90 mm Hg (OR, 31.4; P = .0011), and (3) preoperative clonidine use (OR, 7.3; P = .029). The BP response rate varied significantly based on the number of predictors present per patient (P < .0001). Among patients with three-drug hypertension, a larger ipsilateral kidney (volume ≥150 cm(3)) increased the BP response rate more than threefold compared with patients with smaller kidneys (63% vs 18% BP response rate; P = .018).
CONCLUSIONS: The current study demonstrated that three clinical predictors (≥4 antihypertensive medications, diastolic BP ≥90 mm Hg, and clonidine use) are preoperative predictors of BP response to RAS. Kidney volume may help in discriminating responders from nonresponders among those patients with three-drug hypertension. These parameters may assist clinicians in patient selection and provide more concrete data with which to counsel patients on the likely outcomes for RAS.
Authors:
J Gregory Modrall; Eric B Rosero; David Leonard; Carlos H Timaran; Thomas Anthony; Frank A Arko; R James Valentine; G Patrick Clagett; Clayton Trimmer
Publication Detail:
Type:  Journal Article     Date:  2011-02-12
Journal Detail:
Title:  Journal of vascular surgery     Volume:  53     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-17     Completed Date:  2011-07-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1282-89; discussion 1289-90     Citation Subset:  IM    
Copyright Information:
Published by Mosby, Inc.
Affiliation:
Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA. greg.modrall@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty / adverse effects,  instrumentation*
Antihypertensive Agents / therapeutic use
Blood Pressure*
Chi-Square Distribution
Clonidine / therapeutic use
Drug Therapy, Combination
Female
Humans
Hypertension, Renovascular / diagnosis,  physiopathology,  therapy*
Kidney / blood supply,  pathology*,  radiography
Logistic Models
Magnetic Resonance Imaging
Male
Middle Aged
Odds Ratio
Organ Size
Patient Selection*
Renal Artery Obstruction / diagnosis,  physiopathology,  therapy*
Retrospective Studies
Stents*
Texas
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 4205-90-7/Clonidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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