Iwashima Y, et al. - The prognostic impact of renal function was assessed in patients who underwent percutaneous transluminal angioplasty. Findings demonstrated that impaired renal function, and in particular, a poor response of estimated glomerular filtration rate to angioplasty, was related to worse outcome. In patients with albuminuria/proteinuria, a limited therapeutic effectiveness of renal angioplasty appeared in this work.

Methods

• This study included a total of 139 hypertensive patients with atherosclerotic renal artery stenosis (mean age, 70 years, 80.6% men) who underwent renal percutaneous transluminal angioplasty.
• Based on the estimated glomerular filtration rate (eGFR) and albuminuria/proteinuria, renal function was assessed.
• Three renal functional categories were formed according to eGFR (≥45, 30–44, and <30 ml/min/1.73 m²) and albuminuria/proteinuria [normal-to-mild: albumin/creatinine ratio (ACR) less than 3.0, protein/creatinine ratio (PCR) less than 15; moderate: ACR 3.0–30.0, PCR 15–50; severe: ACR > 30.0, PCR > 50 mg/mmol].

Results

• Findings demonstrated that 36.0% of patients developed the primary composite end point, including cardiovascular and renal outcomes during a median follow-up of 5.4 years.
• Worse outcome was independently predicted by eGFR less than 30 (hazard ratio 3.47, P < 0.01) as well as severe albuminuria/proteinuria (hazard ratio 2.63, P < 0.05) in multivariate Cox regression analysis.
• In the subgroup without events within 1 year after angioplasty (n = 117), difference was reported in the outcome between the three renal functional categories at 1 year based on eGFR (log-rank Χ² = 16.28, P < 0.001) as well as on albuminuria/proteinuria (log-rank Χ²2 = 8.30, P < 0.05).
• Researchers found that at 1 year, at least 20% decrease in eGFR was displayed by 24 patients (20.1%), with worse outcome than that in those with at least 20% increase (n = 23) (hazard ratio 3.50, P < 0.05).
• Pretreatment moderate-to-severe albuminuria/proteinuria independently predicted at least 20% eGFR decrease (odds ratio 2.82, P < 0.05), as indicated in multiple logistic regression analysis.