NDT Advance Access published online on August 7, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp393
Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis
1 Division of Cardiovascular Diseases 2 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA 3 Charles University, Hradec Karlove, Czech Republic 4 Department of Radiology, Mayo Clinic, Rochester, MN, USA
Correspondence and offprint requests to: Vesna D. Garovic; E-mail: garovic.vesna{at}mayo.edu
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Abstract |
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Background. Renal artery stenosis (RAS) impacts the pathogenesis and control of heart failure (HF) and may further contribute to increased cardiovascular morbidity and mortality in HF patients. However, the long-term effects of renal artery revascularization on cardiovascular outcomes in HF patients are not well studied.
Methods. The prevalence of HF and its effects on all-cause mortality were studied in 163 consecutive patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/dL) who underwent percutaneous transluminal renal angioplasty (PTRA) with stenting for atherosclerotic RAS. In addition, in 100 patients with RAS and coexistent HF, we compared the impact of medical treatment (n = 50) versus PTRA (n = 50) on clinical outcomes.
Results. HF (predominantly normal ejection fraction) was present in 50/163 (31%) patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/ dL) undergoing PTRA for RAS and represented the major predictor of all-cause mortality in these patients. When compared with sex-matched RAS and HF patients treated medically, PTRA with stenting was associated with a significant decrease in the New York Heart Association Functional Class (1.9 ± 0.8 versus 2.6 ± 1.0, P < 0.04) and a 5-fold reduction in the number of hospitalizations. However, renal artery revascularization did not impact mortality.
Conclusion. HF was present in one-third of patients with renal dysfunction and atherosclerotic RAS who were referred for PTRA. The presence of HF was associated with a significantly increased risk of death after PTRA with stenting. Renal artery revascularization resulted in improved HF control and a reduction in HF hospitalizations.
Keywords: heart failure (HF); hypertension; percutaneous transluminal renal angioplasty (PTRA); pulmonary oedema; renal artery stenosis (RAS)
Received for publication: 17. 5.09
Accepted in revised form: 13. 7.09