Attenuation of Renal Functional Decline Following Angioplasty and Stenting in Atherosclerotic Renovascular Disease
| Autor: | Diana Vassallo, Luis Cuadrado Martin, Pasqual Barretti, Rodrigo Hagemann, Roberto Jorge da Silva Franco, Philip A. Kalra, Fábio Cardoso de Carvalho, Vanessa dos Santos Silva |
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| Přispěvatelé: | Universidade Estadual Paulista (Unesp) |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Atherosclerotic renovascular disease Renal revascularization 030204 cardiovascular system & hematology Revascularization Kidney Kidney Function Tests 03 medical and health sciences 0302 clinical medicine Internal medicine Angioplasty medicine Humans In patient 030212 general & internal medicine Longitudinal Studies Functional decline End-stage kidney disease Aged Retrospective Studies Medical treatment business.industry Angiography Middle Aged Atherosclerosis Chronic kidney disease progression Creatinine Cardiology Female Kidney Diseases Stents Radiology Renovascular disease business |
| Zdroj: | Scopus Repositório Institucional da UNESP Universidade Estadual Paulista (UNESP) instacron:UNESP |
| ISSN: | 2235-3186 |
| Popis: | Made available in DSpace on 2018-12-11T17:07:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-01-01 Background: To date, renal revascularization has not been shown to be advantageous when compared to optimized medical treatment in patients with atheromatous renovascular disease (ARVD). This study aims to investigate the effect of revascularization in patients with pre-intervention worsening renal function and in those with stable renal function. Patients and Methods: In this single-centre observational study, patients who were diagnosed with at least 60% angiographic stenosis unilaterally or bilaterally between January 1996 and October 2008 and who were followed-up until February 2011 were retrospectively analysed. Evolution of renal function was determined from the slope of reciprocal of serum creatinine (RCr-slope) before and after diagnostic angiography or revascularization; this required 5 or more creatinine measurements before and at least another 5 measurements post-procedure. Patients were divided into 2 groups: one comprising patients with negative RCr-slope before the procedure and a second group of patients with prior positive RCr-slope. A stepwise, adjusted logistic regression was used to determine the OR of revascularization on attenuation of RCr-slope. Results: Data for 52 patients were analysed. Median age was 64 (58-72) and median follow-up was 15 (8-34) months. Only patients with a negative RCr-slope (-0.0078 (95% CI -0.0174, -0.0033) dl/mg/month) who underwent revascularization manifested an improved RCr-slope during follow-up (+0.0013 (95% CI -0.0002, 0.0039) dl/mg/month, p < 0.001). This finding remained statistically significant even after the adjustment for proteinuria and bilateral arterial disease. Conclusion: Revascularization may be indicated for patients with ARVD and progressively worsening renal function. This patient subgroup should ideally be evaluated in future randomized controlled trials. Disciplina de Nefrologia Departamento de Clínica Médica Faculdade de Medicina de Botucatu Universidade Estadual Paulista (UNESP) Disciplina de Nefrologia Departamento de Clínica Médica Faculdade de Medicina de Botucatu Universidade Estadual Paulista (UNESP) |
| Databáze: | OpenAIRE |
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