Predictors of kidney disease progression after renal artery stenting.

Abstract

Background: Atherosclerotic renovascular disease (ARVD) is the most common cause of renal artery stenosis (RAS). ARVD is associated with an increased risk of progression of kidney disease and high mortality. In this regard, the aim was to evaluate the effects of the factors on kidney functions in short- and long-term follow-ups.

Method: Patients with RAS treated with renal artery stenting since January 2015 were evaluated retrospectively in a single center. The primary endpoint was a decline in the estimated glomerular filtration rate (eGFR) of ≥ 20 ml/min and/or evolution to end stage kidney disease. Predictors of the primary endpoint were determined using the Cox regression model.

Results: Of the 95 patients included, 57 (56.4%) were male, and the mean age was 68.7 ± 10.4. Median serum creatinine (mg/dl) and eGFR (ml/min/1.73 m²) at presentation were 1.57 (IQR, 1.11-2.12) and 40 (27-58). The median follow-up was 31 months. Indications for renal artery revascularization included high blood pressure (34 patients, 35.8%), kidney failure (29 patients, 30.5%), or a mixture of these (32 patients, 33.7%). RAS was unilateral in 67 (70%) patients. In the multivariate Cox regression analysis, serum creatinine (HR 2.03, 95% CI 1.3-3.2, p = 0.002), peak systolic velocity (HR 1.005 per 10 ms, 95% CI 1.001-1.010, p = 0.007), and acute kidney injury after revascularization (HR 10.18, 95% CI 2.3-45.4, p < 0.001) were independent predictors of progression of chronic kidney disease.

Conclusion: Serum creatinine level, peak systolic velocity of the renal artery before revascularization, and acute kidney injury after angiographic intervention are independent predictors of the progression of chronic kidney disease in patients who underwent renal artery stenting.