The following is a summary of “Improving outcomes in atherosclerotic renovascular disease: importance of clinical presentation and multi-disciplinary review,” published in the April 2024 issue of Nephrology by Bhailis et al.
Atherosclerotic kidney artery stenosis may cause problems like hypertension and heart issues. Large trials have yet to show much extra benefit from opening these arteries, but they might miss benefits in specific cases.
Researchers conducted a retrospective study based on specific patient issues to determine if revascularization would help more when done using a team approach.
They reviewed all patients with kidney artery narrowing (>50%) from 2015 to 2020. A team reviewed and decided treatments based on guidelines and patient conditions. Revascularization was considered for specific cases like anatomically significant renal artery stenosis, adequately sized kidney, worsening kidney function, heart failure, or severe hypertension. Everyone got standard medication to control cholesterol, blood pressure, and platelet levels. Treatment outcomes were measured based on the patient’s condition, blood pressure in those with renovascular hypertension, delta glomerular fibrillation rate in those with ischaemic nephropathy, and heart failure readmissions in those with heart failure syndrome.
The results showed that during these 5 years, 127 patients with significant stenosis were reviewed, where 57 of them underwent revascularization, mainly for severe hypertension (n=17), declining kidney function (n=25), heart failures (n=6), or several anatomical stenoses (n=9). Among those treated, 79% showed improvement based on their specific issue—82% saw better blood pressure control, 72% had slower kidney decline, and patients with heart failure had no further admissions. Among patients opting for revascularization with high-grade stenosis, 78% had better pressure control, with 55% also experiencing renal functional benefits.
Investigators concluded that patients would benefit most from revascularization by examining their condition, the severity of artery narrowing, and the kidney’s overall health. This approach led to significant clinical improvements.
Source: link.springer.com/article/10.1007/s40620-024-01902-1
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