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Lack of Evidence on Treatment for Narrowed Kidney Arteries

rom 7,660 in 1996 to 18,520 in 2000. The average charge of RAS angioplasty done in the hospital was $27,800 in 2004, according to data from AHRQ’s Healthcare Cost and Utilization Project. The procedure, like any surgery, carries risks of complications or even death. In addition, the durability of benefits of angioplasty with or without a stent is unclear.

Authors of the systematic literature review concluded that a shortage of direct comparisons between drug therapy and angioplasty has left important questions unanswered, including which therapy is more likely to improve kidney function. HHS’ National Institutes of Health has launched a large clinical trial to compare the benefits of angioplasty with stent placement versus drug treatment, but results are not expected until 2010.

“In an ideal world, doctors and patients confronting an illness should be able to draw upon reliable scientific evidence to make treatment decisions,’’ said AHRQ Director Carolyn M. Clancy, M.D. “Unfortunately, renal artery stenosis is among those for which evidence is lacking. This new review serves an important purpose by identifying where research is needed."

AHRQ’s new review of published studies, completed by the Agency’s Tufts-New England Medical Center Evidence-based Practice Center, has concluded:

* Available evidence on RAS treatments is inadequate to clearly support angioplasty, with or without a stent, over drug therapy. No studies have directly compared the use of stents versus medications.

* The published literature did confirm that drug therapy and angioplasty both improve blood pressure, and they have similar impacts on slowing down the worsening of kidney function. But actual improvements in kidney function have only been reported in angioplasty studies that lacked direct comparisons with other therapies.

* For people with stenosis in both renal arteries, angioplasty may control blood pressure better t
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