Kidney Week

Abstract: FR-PO577

Percutaneous Intervention for Renal Artery Stenosis through the Years 2008 to 2014

Session Information

• Hypertension: Clinical and Translational
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Hypertension

• 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

• Ramakrishnan, Madhuri, University of Missouri Kansas City, Kansas CIty, Missouri, United States

Madhuri Ramakrishnan,

• Taduru, Siva sagar, University of Missouri Kansas City, Kansas CIty, Missouri, United States

Siva sagar Taduru,

• Mustafa, Reem, Kansas University Medical Center, Kansas City, Kansas, United States

Reem Mustafa,

Background

Medical therapy remains the cornerstone of management of renal artery stenosis (RAS) with secondary hypertension. The indications of intervention by renal artery angioplasty with (PTRAS) or without (PTRA) stenting however, remains debated. Several trials in recent years have shown no difference in blood pressure control between medical management and percutaneous intervention. We aim to study the trends of utilization, outcomes, and complication rates of percutaneous intervention for RAS between 2008 to 2014.

Methods

We searched the National Inpatient Sample from 2008 – 2014 using International Classification of Diseases Clinical Modification (ICD-9-CM) codes to identify patients admitted with primary diagnosis of renal atherosclerosis, fibromuscular dysplasia (FMD), or reno-vascular hypertension. We excluded patients with vascular trauma, carotid stenosis, and mesenteric ischemia, to exclude patients who may have undergone endovascular procedures identified for these indications. We then identified patients who underwent PTRA and PTRAS. We identified complications of post-operative hematoma or bleeding, acute kidney injury (AKI), and atheroembolism. We described categorical variables as proportions and continuous variables as means. We analyzed the trend of utilization of the procedure using the Mantel-Haenzsel trend test.

Results

We identified 30,617 patients admitted with primary diagnosis of RAS. The mean age was 68.63 ± 15.5 years, 62.5% of patients were females, 79.5% were Caucasians, and the mean comorbidity score was 6.37 ± 7.33. Of these, 22,716 (74.2%) patients underwent percutaneous intervention. The mean age of these patients was 70.42 ± 12.6 years, 61.4% were females, 81.7% were Caucasians and the mean comorbidity score was 6.0 ± 7.1. We identified a trend towards lower rates of use of percutaneous interventions through our study period (84.1% in 2008 vs 50.7% in 2014, P_trend < 0.0001). Mortality rates were 0.2%, and the mean length of stay was 2.7 ± 3.3 days. Post-operative bleeding or hematoma was identified in 4%, AKI in 11.4% and atheroembolism in 0.3% of cases.

Conclusion

We found a significant downward trend of inpatient PTRA and PTRAS for RAS between 2008 and 2014. This is consistent with the lack of evidence to support the use of interventions. Patients who received intervention tended to be older, with lower comorbidity scores.