Uncontrolled studies of surgery, renal revascularization or medical therapy for ARVD over the past decades
| Author . | Year . | Patients (n) . | Inclusion criteria . | Follow-up in months . | Treatment modality . | Primary end-point . | Key clinical outcomes . | Comments . |
|---|---|---|---|---|---|---|---|---|
| Sheps et al. [5] | 1965 | 54 (22 patients had FMD) |
| 20.3 (Mean) | Medical | Change in renal function and BP control from baseline and mortality |
| Improved retinal hypertensive changes were used as a correlate of controlled BP |
| Wollenweber et al. [4] | 1968 | 109 |
| 42 (mean) | 63—medical 46—surgery | Change in renal function and BP control from baseline, incidence of cardiovascular events and survival |
| Advanced ARVD was associated with more severe extrarenal atherosclerosis and a poorer prognosis. |
| Dean et al. [17] | 1981 | 41 |
| 44 (mean) | medical | 10% loss in renal length, 100% increase in serum creatinine and 50% decrease in isotopic GFR during follow-up |
| – 17/41 (41%) required surgery due to deterioration in renal function or loss of renal length, despite adequate BP control in 15/17 (88%) of patients. |
| Novick et al. [18] | 1984 | 51 |
| 46 (mean) | surgery | Change in renal function from baseline and survival post-surgical revascularization |
| In selected patients with ARVD, renal revascularization may improve survival |
| Brawn et al. [19] | 1987 | 29 |
| 20 (mean) | 29 – PTRA 25 – (Non-randomised ‘controls’)—medical | Change in BP from baseline |
| 25 hypertensive patients without underlying renovascular disease were used as non-randomized ‘controls’—8/25 (32%) had spontaneous improvement in BP. |
| Dean et al. [7] | 1991 | 58 |
| 19.8 (Mean) | surgery | Change in eGFR by at least 20% from baseline at least 1 week post-operatively and change in BP and anti-hypertensive medication requirements at least 8 weeks post-operatively. |
| Patients with bilateral disease had a significant improvement in eGFR after intervention (P = 0.0001) unlike patients with unilateral disease. |
| Van de Ven et al. [20] | 1995 | 24 | – Ostial ARVD (≥50%) with refractory hypertension or rise in sCr with ACEi | 6 | Primary/secondary PTRAS (Palmaz) | Primary success rate and restenosis at 6 months | Diastolic BP <90 mmHg with anti-hypertensive medication: 15/24 (63%) ESKD (cholesterol embolization): 2/24 (8.3%)
| ACEi could be restarted without causing deterioration in renal function. |
| Harden et al. [10] | 1997 | 32 |
| 17 (Mean follow-up before stenting) 8 (Mean follow-up after stenting) | Primary/Secondary PTRAS (Palmaz) | 20% Change in serum creatinine from baseline, initiation of renal replacement therapy and death |
| Improved slope of deterioration of renal function compared with that before stenting. |
| Chabova et al. [21] | 2000 | 68 |
| 38.9 (Mean) | 68—Medical | Change in renal function and BP from baseline and clinical outcomes at termination |
| Patients with bilateral renal artery disease had a higher mortality (P = 0.07) and a higher risk of deteriorating renal function than patients with unilateral disease. |
| Losito et al. [11] | 2005 | 195 | – ARAS >50% | 54 (mean) | 136—PTRA/PTRAS 54—medical treatment | Change in renal function and BP from baseline and survival | PTRA—slightly lower increase in creatinine over time (P = 0.041) and better BP control (P < 0.05). ESKD: – 13/136 (9.5%)—PTRA/PTRAS; 7/54 (13%)—medical treatment | Intervention had no effect on survival or incidence of ESKD. Baseline creatinine, rather than degree of RAS, was a predictor of reaching ESKD. |
| Jaff et al. [22] (HERCULES) | 2012 | 202 |
| 9 | PTRAS (Herculink Elite stent) | 9-Month binary restenosis rate as determined by duplex ultrasound and/or angiography | Restenosis at 9 months
2/202 (1%)—atheromatous embolization and kidney injury | This cohort of patients had refractory hypertension despite the fact that 75% were taking ACEi/ARB. Revascularization optimized BP control in this selected cohort, and degree of BP reduction correlated with baseline BP. There was no correlation between BP response to revascularization and baseline BNP or BNP reduction. |
| Author . | Year . | Patients (n) . | Inclusion criteria . | Follow-up in months . | Treatment modality . | Primary end-point . | Key clinical outcomes . | Comments . |
|---|---|---|---|---|---|---|---|---|
| Sheps et al. [5] | 1965 | 54 (22 patients had FMD) |
| 20.3 (Mean) | Medical | Change in renal function and BP control from baseline and mortality |
| Improved retinal hypertensive changes were used as a correlate of controlled BP |
| Wollenweber et al. [4] | 1968 | 109 |
| 42 (mean) | 63—medical 46—surgery | Change in renal function and BP control from baseline, incidence of cardiovascular events and survival |
| Advanced ARVD was associated with more severe extrarenal atherosclerosis and a poorer prognosis. |
| Dean et al. [17] | 1981 | 41 |
| 44 (mean) | medical | 10% loss in renal length, 100% increase in serum creatinine and 50% decrease in isotopic GFR during follow-up |
| – 17/41 (41%) required surgery due to deterioration in renal function or loss of renal length, despite adequate BP control in 15/17 (88%) of patients. |
| Novick et al. [18] | 1984 | 51 |
| 46 (mean) | surgery | Change in renal function from baseline and survival post-surgical revascularization |
| In selected patients with ARVD, renal revascularization may improve survival |
| Brawn et al. [19] | 1987 | 29 |
| 20 (mean) | 29 – PTRA 25 – (Non-randomised ‘controls’)—medical | Change in BP from baseline |
| 25 hypertensive patients without underlying renovascular disease were used as non-randomized ‘controls’—8/25 (32%) had spontaneous improvement in BP. |
| Dean et al. [7] | 1991 | 58 |
| 19.8 (Mean) | surgery | Change in eGFR by at least 20% from baseline at least 1 week post-operatively and change in BP and anti-hypertensive medication requirements at least 8 weeks post-operatively. |
| Patients with bilateral disease had a significant improvement in eGFR after intervention (P = 0.0001) unlike patients with unilateral disease. |
| Van de Ven et al. [20] | 1995 | 24 | – Ostial ARVD (≥50%) with refractory hypertension or rise in sCr with ACEi | 6 | Primary/secondary PTRAS (Palmaz) | Primary success rate and restenosis at 6 months | Diastolic BP <90 mmHg with anti-hypertensive medication: 15/24 (63%) ESKD (cholesterol embolization): 2/24 (8.3%)
| ACEi could be restarted without causing deterioration in renal function. |
| Harden et al. [10] | 1997 | 32 |
| 17 (Mean follow-up before stenting) 8 (Mean follow-up after stenting) | Primary/Secondary PTRAS (Palmaz) | 20% Change in serum creatinine from baseline, initiation of renal replacement therapy and death |
| Improved slope of deterioration of renal function compared with that before stenting. |
| Chabova et al. [21] | 2000 | 68 |
| 38.9 (Mean) | 68—Medical | Change in renal function and BP from baseline and clinical outcomes at termination |
| Patients with bilateral renal artery disease had a higher mortality (P = 0.07) and a higher risk of deteriorating renal function than patients with unilateral disease. |
| Losito et al. [11] | 2005 | 195 | – ARAS >50% | 54 (mean) | 136—PTRA/PTRAS 54—medical treatment | Change in renal function and BP from baseline and survival | PTRA—slightly lower increase in creatinine over time (P = 0.041) and better BP control (P < 0.05). ESKD: – 13/136 (9.5%)—PTRA/PTRAS; 7/54 (13%)—medical treatment | Intervention had no effect on survival or incidence of ESKD. Baseline creatinine, rather than degree of RAS, was a predictor of reaching ESKD. |
| Jaff et al. [22] (HERCULES) | 2012 | 202 |
| 9 | PTRAS (Herculink Elite stent) | 9-Month binary restenosis rate as determined by duplex ultrasound and/or angiography | Restenosis at 9 months
2/202 (1%)—atheromatous embolization and kidney injury | This cohort of patients had refractory hypertension despite the fact that 75% were taking ACEi/ARB. Revascularization optimized BP control in this selected cohort, and degree of BP reduction correlated with baseline BP. There was no correlation between BP response to revascularization and baseline BNP or BNP reduction. |
ACEi, angiotensin-converting enzyme inhibitor; ARAS, atherosclerotic renal artery stenosis; ARB, angiotensin receptor blocker; ARVD, atherosclerotic renovascular disease; BNP, brain natriuretic peptide; BP, blood pressure; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; FMD, fibromuscular dysplasia; PTRA, percutaneous transluminal renal angioplasty; PTRAS, percutaneous transluminal renal angioplasty and stenting; RAS, renal artery stenosis; RF, renal function; RVH, renovascular hypertension; Rx, treatment; sCr, serum creatinine.
aDefined as diastolic BP <95 or 90 mmHg with no anti-hypertensive medication.
bDefined as diastolic BP <90 mmHg.
csCr decreased by >20% from baseline.
Uncontrolled studies of surgery, renal revascularization or medical therapy for ARVD over the past decades
| Author . | Year . | Patients (n) . | Inclusion criteria . | Follow-up in months . | Treatment modality . | Primary end-point . | Key clinical outcomes . | Comments . |
|---|---|---|---|---|---|---|---|---|
| Sheps et al. [5] | 1965 | 54 (22 patients had FMD) |
| 20.3 (Mean) | Medical | Change in renal function and BP control from baseline and mortality |
| Improved retinal hypertensive changes were used as a correlate of controlled BP |
| Wollenweber et al. [4] | 1968 | 109 |
| 42 (mean) | 63—medical 46—surgery | Change in renal function and BP control from baseline, incidence of cardiovascular events and survival |
| Advanced ARVD was associated with more severe extrarenal atherosclerosis and a poorer prognosis. |
| Dean et al. [17] | 1981 | 41 |
| 44 (mean) | medical | 10% loss in renal length, 100% increase in serum creatinine and 50% decrease in isotopic GFR during follow-up |
| – 17/41 (41%) required surgery due to deterioration in renal function or loss of renal length, despite adequate BP control in 15/17 (88%) of patients. |
| Novick et al. [18] | 1984 | 51 |
| 46 (mean) | surgery | Change in renal function from baseline and survival post-surgical revascularization |
| In selected patients with ARVD, renal revascularization may improve survival |
| Brawn et al. [19] | 1987 | 29 |
| 20 (mean) | 29 – PTRA 25 – (Non-randomised ‘controls’)—medical | Change in BP from baseline |
| 25 hypertensive patients without underlying renovascular disease were used as non-randomized ‘controls’—8/25 (32%) had spontaneous improvement in BP. |
| Dean et al. [7] | 1991 | 58 |
| 19.8 (Mean) | surgery | Change in eGFR by at least 20% from baseline at least 1 week post-operatively and change in BP and anti-hypertensive medication requirements at least 8 weeks post-operatively. |
| Patients with bilateral disease had a significant improvement in eGFR after intervention (P = 0.0001) unlike patients with unilateral disease. |
| Van de Ven et al. [20] | 1995 | 24 | – Ostial ARVD (≥50%) with refractory hypertension or rise in sCr with ACEi | 6 | Primary/secondary PTRAS (Palmaz) | Primary success rate and restenosis at 6 months | Diastolic BP <90 mmHg with anti-hypertensive medication: 15/24 (63%) ESKD (cholesterol embolization): 2/24 (8.3%)
| ACEi could be restarted without causing deterioration in renal function. |
| Harden et al. [10] | 1997 | 32 |
| 17 (Mean follow-up before stenting) 8 (Mean follow-up after stenting) | Primary/Secondary PTRAS (Palmaz) | 20% Change in serum creatinine from baseline, initiation of renal replacement therapy and death |
| Improved slope of deterioration of renal function compared with that before stenting. |
| Chabova et al. [21] | 2000 | 68 |
| 38.9 (Mean) | 68—Medical | Change in renal function and BP from baseline and clinical outcomes at termination |
| Patients with bilateral renal artery disease had a higher mortality (P = 0.07) and a higher risk of deteriorating renal function than patients with unilateral disease. |
| Losito et al. [11] | 2005 | 195 | – ARAS >50% | 54 (mean) | 136—PTRA/PTRAS 54—medical treatment | Change in renal function and BP from baseline and survival | PTRA—slightly lower increase in creatinine over time (P = 0.041) and better BP control (P < 0.05). ESKD: – 13/136 (9.5%)—PTRA/PTRAS; 7/54 (13%)—medical treatment | Intervention had no effect on survival or incidence of ESKD. Baseline creatinine, rather than degree of RAS, was a predictor of reaching ESKD. |
| Jaff et al. [22] (HERCULES) | 2012 | 202 |
| 9 | PTRAS (Herculink Elite stent) | 9-Month binary restenosis rate as determined by duplex ultrasound and/or angiography | Restenosis at 9 months
2/202 (1%)—atheromatous embolization and kidney injury | This cohort of patients had refractory hypertension despite the fact that 75% were taking ACEi/ARB. Revascularization optimized BP control in this selected cohort, and degree of BP reduction correlated with baseline BP. There was no correlation between BP response to revascularization and baseline BNP or BNP reduction. |
| Author . | Year . | Patients (n) . | Inclusion criteria . | Follow-up in months . | Treatment modality . | Primary end-point . | Key clinical outcomes . | Comments . |
|---|---|---|---|---|---|---|---|---|
| Sheps et al. [5] | 1965 | 54 (22 patients had FMD) |
| 20.3 (Mean) | Medical | Change in renal function and BP control from baseline and mortality |
| Improved retinal hypertensive changes were used as a correlate of controlled BP |
| Wollenweber et al. [4] | 1968 | 109 |
| 42 (mean) | 63—medical 46—surgery | Change in renal function and BP control from baseline, incidence of cardiovascular events and survival |
| Advanced ARVD was associated with more severe extrarenal atherosclerosis and a poorer prognosis. |
| Dean et al. [17] | 1981 | 41 |
| 44 (mean) | medical | 10% loss in renal length, 100% increase in serum creatinine and 50% decrease in isotopic GFR during follow-up |
| – 17/41 (41%) required surgery due to deterioration in renal function or loss of renal length, despite adequate BP control in 15/17 (88%) of patients. |
| Novick et al. [18] | 1984 | 51 |
| 46 (mean) | surgery | Change in renal function from baseline and survival post-surgical revascularization |
| In selected patients with ARVD, renal revascularization may improve survival |
| Brawn et al. [19] | 1987 | 29 |
| 20 (mean) | 29 – PTRA 25 – (Non-randomised ‘controls’)—medical | Change in BP from baseline |
| 25 hypertensive patients without underlying renovascular disease were used as non-randomized ‘controls’—8/25 (32%) had spontaneous improvement in BP. |
| Dean et al. [7] | 1991 | 58 |
| 19.8 (Mean) | surgery | Change in eGFR by at least 20% from baseline at least 1 week post-operatively and change in BP and anti-hypertensive medication requirements at least 8 weeks post-operatively. |
| Patients with bilateral disease had a significant improvement in eGFR after intervention (P = 0.0001) unlike patients with unilateral disease. |
| Van de Ven et al. [20] | 1995 | 24 | – Ostial ARVD (≥50%) with refractory hypertension or rise in sCr with ACEi | 6 | Primary/secondary PTRAS (Palmaz) | Primary success rate and restenosis at 6 months | Diastolic BP <90 mmHg with anti-hypertensive medication: 15/24 (63%) ESKD (cholesterol embolization): 2/24 (8.3%)
| ACEi could be restarted without causing deterioration in renal function. |
| Harden et al. [10] | 1997 | 32 |
| 17 (Mean follow-up before stenting) 8 (Mean follow-up after stenting) | Primary/Secondary PTRAS (Palmaz) | 20% Change in serum creatinine from baseline, initiation of renal replacement therapy and death |
| Improved slope of deterioration of renal function compared with that before stenting. |
| Chabova et al. [21] | 2000 | 68 |
| 38.9 (Mean) | 68—Medical | Change in renal function and BP from baseline and clinical outcomes at termination |
| Patients with bilateral renal artery disease had a higher mortality (P = 0.07) and a higher risk of deteriorating renal function than patients with unilateral disease. |
| Losito et al. [11] | 2005 | 195 | – ARAS >50% | 54 (mean) | 136—PTRA/PTRAS 54—medical treatment | Change in renal function and BP from baseline and survival | PTRA—slightly lower increase in creatinine over time (P = 0.041) and better BP control (P < 0.05). ESKD: – 13/136 (9.5%)—PTRA/PTRAS; 7/54 (13%)—medical treatment | Intervention had no effect on survival or incidence of ESKD. Baseline creatinine, rather than degree of RAS, was a predictor of reaching ESKD. |
| Jaff et al. [22] (HERCULES) | 2012 | 202 |
| 9 | PTRAS (Herculink Elite stent) | 9-Month binary restenosis rate as determined by duplex ultrasound and/or angiography | Restenosis at 9 months
2/202 (1%)—atheromatous embolization and kidney injury | This cohort of patients had refractory hypertension despite the fact that 75% were taking ACEi/ARB. Revascularization optimized BP control in this selected cohort, and degree of BP reduction correlated with baseline BP. There was no correlation between BP response to revascularization and baseline BNP or BNP reduction. |
ACEi, angiotensin-converting enzyme inhibitor; ARAS, atherosclerotic renal artery stenosis; ARB, angiotensin receptor blocker; ARVD, atherosclerotic renovascular disease; BNP, brain natriuretic peptide; BP, blood pressure; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; FMD, fibromuscular dysplasia; PTRA, percutaneous transluminal renal angioplasty; PTRAS, percutaneous transluminal renal angioplasty and stenting; RAS, renal artery stenosis; RF, renal function; RVH, renovascular hypertension; Rx, treatment; sCr, serum creatinine.
aDefined as diastolic BP <95 or 90 mmHg with no anti-hypertensive medication.
bDefined as diastolic BP <90 mmHg.
csCr decreased by >20% from baseline.
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