Delay of dialysis in end-stage renal failure: prospective study on percutaneous renal artery interventions

Renal artery stenosis (RAS) is a cause of end-stage renal failure. We studied the effect of percutaneous renal artery intervention (PRI) in patients with advanced, progressive disease at risk for renal failure, hypothesizing a beneficial effect.

Thirty-nine primary and 14 secondary PRIs were performed on 28 patients with atherosclerotic RAS, serum creatinine >300 micromol/L, and progressive loss of renal function >/=1 year before PRI. Renal function and RA patency were prospectively followed for 12 months after primary and secondary PRI. The intervention's effect on the progressive loss of renal function was calculated by comparing reciprocal slopes of serum creatinine against time before and after PRI.

Progression of renal failure slowed significantly following PRI. Mean (+/-SE) slopes of reciprocal serum creatinine values were: 6.69 +/- 0.97 L micromol(-1) day(-1) (x10(-6)) before and 6.76 +/- 3.03 L micromol(-1) day(-1) (x10(-6)) after PRI (P= 0.0007). Fifteen patients (53.5%) showed improvement or stabilization of progressive renal dysfunction. Out of 11 patients expected to become dialysis dependent within one year, 8 (72.7%) experienced an improvement in renal function sufficient to remain dialysis-free. Favorable outcome correlated with a lower creatinine level (P= 0.0137) and a more negative slope of progression (r= 0.49, P= 0.020) at entry. Mortality was 10.7%, and rate of local complications was 7.1%. Deterioration of renal function following PRI was suspected in 17.9% of patients.

PRI may improve renal function and ultimately delay dialysis in patients with advanced renal failure. Possible advantages must be weighed against the risk of renal failure advancement and high procedure-related complication rate.