Clinical and kidney morphologic predictors of outcome for renal artery stenting: Data to inform patient selection

J. Gregory Modrall, Eric B. Rosero, David Leonard, Carlos H. Timaran, Thomas Anthony, Frank A. Arko, R. James Valentine, G. Patrick Clagett, Clayton Trimmer

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

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 cm3) 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.

Original languageEnglish (US)
Pages (from-to)1282-1290
Number of pages9
JournalJournal of vascular surgery
Volume53
Issue number5
DOIs
StatePublished - May 1 2011
Externally publishedYes

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    Modrall, J. G., Rosero, E. B., Leonard, D., Timaran, C. H., Anthony, T., Arko, F. A., Valentine, R. J., Clagett, G. P., & Trimmer, C. (2011). Clinical and kidney morphologic predictors of outcome for renal artery stenting: Data to inform patient selection. Journal of vascular surgery, 53(5), 1282-1290. https://doi.org/10.1016/j.jvs.2010.11.103