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Published on: October 26, 2020
Predictive factors and therapeutic approach of renovascular disease: four years' follow-up
Stavroula Ziakka1, Michaela Ursu, Dimitris Poulikakos
1Nephrology Department,Corgialenio-Benakio Hospital, Athens, Greece.
Insights
Revascularization for atherosclerotic renovascular disease did not improve renal survival compared to medical treatment. However, it offered better blood pressure control, while eosinophil count and oxidative stress predicted kidney function decline.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Consensus is lacking on renal function outcomes post-revascularization for atherosclerotic renovascular disease.
- This study compares outcomes of stenting versus medical treatment for renovascular disease.
- Investigates oxidative stress and eosinophil count as predictors of renal function deterioration.
Purpose of the Study:
- To compare blood pressure control and renal function in patients with renovascular disease treated with stenting versus medical therapy.
- To identify predictors of renal function deterioration in renovascular disease.
Main Methods:
- Eighty-two patients with renovascular disease were followed for 47.5 months.
- Thirty-six patients underwent revascularization with stenting (group 1), 46 received medical treatment (group 2).
- Serum creatinine, eosinophil count, and oxidative stress (dROMs) were measured pre- and post-treatment.
Main Results:
- Revascularization improved hypertension in 77.7% of patients; 30.5% showed improved renal function, 36.2% worsened.
- Medical treatment improved hypertension in 71.4%; renal function remained stable in 69.8%, worsened in 30.2%.
- Higher eosinophil counts and oxidative stress levels predicted renal function deterioration regardless of treatment.
Conclusions:
- Revascularization did not offer superior renal survival compared to medical treatment.
- Revascularization demonstrated a greater positive impact on blood pressure control.
- Eosinophil count and oxidative stress are significant predictors of increased serum creatinine.
Background:
There is no consensus about the renal function outcome after revascularization with stenting in atherosclerotic renovascular disease. In the present study, the outcome in BP control and renal function in patients with renovascular disease treated with percutaneous angioplasty and stent placement is compared with the outcome in patients with renovascular disease treated with medical treatment only. Additionally, the impact of oxidative stress and eosinophil count in peripheral blood as predictors of renal function deterioration in renovascular disease irrespective of treatment is investigated.
Methods:
Eighty-two patients with renovascular disease were enrolled into a follow-up study (47.5+/-35.4 months). Thirty-six patients (group 1) underwent revascularization and stenting, and 46 patients (group 2) were on medical treatment only. In all patients, serum creatinine concentration, eosinophil count (EO) in peripheral blood, and estimation of oxidative stress with dROMs test were determined before and at the end of the follow-up.
Results:
In revascularized patients (group 1), hypertension was cured in 11.1% and improved in 66.6%. Renal function improved in 30.5% and worsened in 36.2% of patients. In the medical treatment arm (group 2), hypertension improved in 71.4% of the patients. Renal function remained stable in 69.8% of patients and worsened in 30.2%. Cox regression analysis showed that higher levels of eosinophil count and higher levels of ROS, irrespectively of mode of treatment, were associated with renal function deterioration (i.e., serum creatinine increase more than 20% during follow-up).
Conclusions:
Revascularization was not superior to medical treatment in renal survival but had a greater positive impact on blood pressure control. Eosinophil count and oxidative stress were the stronger predictive factors for serum creatinine increase.
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