Determinants of renal function in patients with renal artery stenosis

Haifeng Yu, Dong Zhang, Steven Haller, Khalil Kanjwal, William Colyer, Pamela Brewster, Michael Steffes, Joseph I. Shapiro, Christopher J. Cooper

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Renal artery stenosis (RAS) is an important cause of renal failure; however, the factors associated with loss of kidney function in patients with RAS are poorly described, as are the predictors of an improvement in kidney function after stenting. One hundred patients at seven centers undergoing renal stenting were randomly assigned to an embolic protection device or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor. The glomerular filtration rate (GFR) was measured using the creatinine-derived modified Modification of Diet in Renal Disease (MDRD) equation, cystatin C, and iohexol clearance. In univariate and multivariate models, baseline MDRD and cystatin C GFR were associated with congestive heart failure (CHF) (p = 0.01), lesion length (p = 0.01), and percent stenosis (-0.27, p = 0.01). In multivariate models, MDRD-estimated GFR 1 month after stenting was associated with bilateral stenosis (p < 0.05) and lesion length (p < 0.05), whereas with cystatin C the multivariate model included angiotensin receptor blocker (ARB) (p < 0.05) and minimal luminal diameter (MLD) (p < 0.05). The improvement in GFR from baseline to 1 month, measured as percent change, was related to baseline MDRD (p = 0.009) and cystatin C (p = 0.03) GFR. For MDRD GFR combined treatment with abciximab and Angioguard® embolic protection (p = 0.02) remained significant in multivariate analysis as did CHF, which was also significant with cystatin C (p = 0.05). In conclusion, CHF and lesion characteristics (MLD, percent stenosis and lesion length) are determinants of renal function in patients with RAS. In contrast, the acute improvement in renal function after revascularization is most strongly influenced by baseline GFR, and to a lesser degree CHF and combined procedural treatment with abciximab and embolic protection but not lesion characteristics.

Original languageEnglish (US)
Pages (from-to)331-338
Number of pages8
JournalVascular Medicine
Volume16
Issue number5
DOIs
StatePublished - Oct 2011

Bibliographical note

Funding Information:
The data utilized for the current study was collected in a clinical trial funded by unrestricted research grants from Centocor Inc. and Cordis Corporations that are Johnson & Johnson companies. Dr Cooper is funded by the National Heart, Lung and Blood Institute 5U01HL071556.

Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.

Keywords

  • kidney failure
  • renal artery
  • renal artery obstruction

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