A study on the outcome of percutaneous transluminal renal angioplasty in patients with renal failure.

BACKGROUND: The indications for percutaneous transluminal renal angioplasty (PTRA) in renovascular disease, as well as its benefits, remain a matter of debate. The aim of this study was to evaluate the outcome of angioplasty and to identify risk factors associated with less successful outcomes in patients with atheromatous renal artery stenosis and renal failure of varying degrees.

METHODS: The results of PTRA were analyzed retrospectively in 144 patients with serum creatinine levels of >130 micromol/l. Patients were divided into 5 groups according to their indication for angioplasty: (1) deteriorating renal function; (2) accelerating hypertension; (3) a combination of 1 and 2; (4) peripheral vascular disease, and (5) miscellaneous conditions.

RESULTS: The baseline mean (+/- SD) systolic and diastolic blood pressures of the entire group were lowered from 180 +/- 32 and 95 +/- 16 mm Hg to 162 +/- 23 and 86 +/- 12 mm Hg, respectively (p < 0.0005), 12 months after angioplasty. The blood pressure level was unaffected by angioplasty in patients with claudication. The mean number of antihypertensive drugs was reduced in the group with accelerating hypertension from 2.9 +/- 0.8 to 2.4 +/- 1.2 (p = 0.019), and in the group with unilateral renal artery stenosis and two kidneys from 2.4 +/- 1.0 to 1.8 +/- 1.1 (p = 0.002), 12 months after PTRA. Glomerular filtration rate at 3-month follow-up had increased from 23 +/- 11 to 27 +/- 14 ml/min/1.73 m(2) (p = 0.021) in group 1, from 25 +/- 11 to 28 +/- 14 ml/min/1.73 m(2) (p = 0.031) in the combined group of patients consisting of groups 1 and 3, and from 32 +/- 13 to 35 +/- 14 ml/min/1.73 m(2) (p = 0.019) in the group with unilateral renal artery stenosis. No statistically significant difference was found in any of these 3 groups 1 year after angioplasty. The first patient group had an increased prevalence of cardiovascular disease, aortic aneurysm, carotid occlusive disease, and peripheral vascular disease compared to the other patient groups (p < 0.05). Patients with baseline creatinine levels of >300 micromol/l had a lower survival rate at 12, 60, and 120 months after PTRA than patients with serum creatinine levels of <300 micromol/l (p < 0.005). Survival was also lower in patients with bilateral renal artery stenosis and those with a single kidney, compared to patients with a unilateral stenosis at both 5 and 10 years after PTRA (p < 0.05). Regression analysis of predictor variables of mortality rate showed that the relative risk (RR) associated with increased serum creatinine was 4.7 (CI 2.0-11.0; p < 0.0005). The RR for older patients was 1.1 (CI 1.0-1.2; p = 0.008), and the RR for former smokers was 6.0 (CI 1.6-24.0; p = 0.009).

CONCLUSION: The results of the present study indicate that glomerular filtration can be improved in patients who primarily undergo angioplasty to rescue renal function. Renal function with creatinine levels of >300 micromol/l was associated with a lower survival rate. It is, therefore, possible that patients selected after a thorough evaluation of their renal function and comorbid disease factors may benefit from PTRA, even when the indication for angioplasty is to salvage renal function.