Contemporary Trends in Disparities for Renal Artery Stenting and Angioplasty in the United States

Over the past 2 decades, several randomized clinical studies, including the STAR, ASTRAL, and CORAL trials, investigated interventions for atherosclerotic renal artery stenosis (RAS). However, a gap exists in the available data concerning racial disparities in the context of endovascular intervention for RAS. To address this gap, we conducted a comprehensive investigation utilizing a national database.

The National Inpatient Sample was queried between 2005 to 2019, for adult patients with RAS. Endovascular interventions included angioplasty and/or stenting. The Cochran-Armitage test was conducted to assess trends in the proportion of endovascular intervention among races. Multivariable logistic regression was used to assess the patient profile of those who received endovascular intervention, nonroutine discharge, and in-hospital mortality. Admissions involving fibromuscular dysplasia and open intervention were excluded.

In total, 792,108 admissions involving RAS were identified; 634,801 were White patients, 80,585 were Black patients, 44,415 were Hispanic, 12,409 were Asian or Pacific Islander, 3879 were Native American, and 16,019 were of other race. The proportion of utilization of endovascular procedures was trending downward by an average of -2.0% per year (P < .001). The proportion of White patients who underwent renal stent placement decreased by -2.0% per year, Black patients decreased by -1.5% per year, Hispanic patients decreased by -2.2% per year, Asian or Pacific Islander patients decreased by -1.9% per year, Native American patients decreased by -2.4% per year, and those of the other race decreased by -1.8% per year (all P < .001). Compared to White patients, Black patients had lower odds of undergoing endovascular procedure (OR, 0.80; P < .001), lower odds of routine discharge (OR, 0.86; P < .001), and lower odds of in-hospital mortality (OR, 0.86; P = .023).

Over the 15-year study period, there was a decreasing trend in the proportion of endovascular intervention for RAS for both White and non-White patients, though the decrease in trend was larger among White patients. Additionally, Black patients had lower odds of undergoing endovascular treatment, lower odds of routine discharge, and lower odds of mortality compared to White patients.