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Renal artery stenting falls short in large randomized trial
Date:4/1/2008

coronary and peripheral arterial disease; indeed, these conditions share common risk factors. At least 30 percent of older patients with chronic congestive heart failure have renal artery stenosis. Perhaps most important, uncontrolled high blood pressure often prompts physicians to suspect renal artery stenosisand to treat it with angioplasty and stenting.

To evaluate the clinical effectiveness of renal artery stenting, Dr. Kalra and his colleagues recruited 806 patients with atherosclerotic renal vascular disease (ARVD) from 54 medical centers in the United Kingdom, and four in Australia and New Zealand. Patients had renal failure, with an average serum creatinine of about 2.0 mg/dL. Baseline blood pressure averaged 151/76 mm Hg. More than half were current or ex-smokers, nearly one-third had diabetes and nearly half had coronary artery disease. The degree of renal artery stenosis at baseline was 76 percent, on average.

The researchers randomly assigned patients to catheter-based intervention plus medical therapy or medical therapy alone. Renal artery stenting was successful in widening the renal artery, achieving a residual stenosis of less than 50 percent in 88 percent of patients.

After one year of follow-up, however, there were no differences in the change in serum creatinineit rose by 0.2 mg/dL in both groupsor in rates of renal events, including acute renal failure. Even in the highest-risk patientsthose with a baseline creatinine in the highest third, or who had experienced a rapid deterioration in kidney function in the preceding yearrenal artery angioplasty and stenting offered no significant renal functional benefit at one year, but patient numbers in these sub-groups were fairly small.

Blood pressure fell slowly over time, and by four years, averaged 146/74 mm Hg in both groups. At one year, there was no significant difference in the rates of heart attack, stroke, hospitalization for chest pain or heart failure or t
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Source:Eurekalert

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