Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis

Nephrol Dial Transplant. 2010 Mar;25(3):813-20. doi: 10.1093/ndt/gfp393. Epub 2009 Aug 7.


Background: Renal artery stenosis (RAS) impacts the pathogenesis and control of heart failure (HF) and may further contribute to increased cardiovascular morbidity and mortality in HF patients. However, the long-term effects of renal artery revascularization on cardiovascular outcomes in HF patients are not well studied.

Methods: The prevalence of HF and its effects on all-cause mortality were studied in 163 consecutive patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/dL) who underwent percutaneous transluminal renal angioplasty (PTRA) with stenting for atherosclerotic RAS. In addition, in 100 patients with RAS and coexistent HF, we compared the impact of medical treatment (n = 50) versus PTRA (n = 50) on clinical outcomes.

Results: HF (predominantly normal ejection fraction) was present in 50/163 (31%) patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/ dL) undergoing PTRA for RAS and represented the major predictor of all-cause mortality in these patients. When compared with sex-matched RAS and HF patients treated medically, PTRA with stenting was associated with a significant decrease in the New York Heart Association Functional Class (1.9 +/- 0.8 versus 2.6 +/- 1.0, P < 0.04) and a 5-fold reduction in the number of hospitalizations. However, renal artery revascularization did not impact mortality.

Conclusion: HF was present in one-third of patients with renal dysfunction and atherosclerotic RAS who were referred for PTRA. The presence of HF was associated with a significantly increased risk of death after PTRA with stenting. Renal artery revascularization resulted in improved HF control and a reduction in HF hospitalizations.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon*
  • Atherosclerosis / complications
  • Atherosclerosis / physiopathology
  • Atherosclerosis / therapy*
  • Blood Pressure / physiology
  • Disease Progression
  • Female
  • Heart Failure / epidemiology
  • Heart Failure / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Regional Blood Flow / physiology
  • Renal Artery / physiopathology*
  • Renal Artery Obstruction / complications
  • Renal Artery Obstruction / physiopathology
  • Renal Artery Obstruction / therapy*
  • Retrospective Studies
  • Risk Factors
  • Stents*
  • Treatment Outcome