Abstract: FR-PO573

Hyperuricemia Is Associated with Worse Renal Outcomes in Patients Undergoing Percutaneous Transluminal Renal Angioplasty (PTRA)

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Chen, Xiaojun, Mayo Clinic, Rochester, Minnesota, United States
  • Eirin, Alfonso, Mayo Clinic, Rochester, Minnesota, United States
  • Saad, Ahmed, Mayo Clinic, Rochester, Minnesota, United States
  • Lerman, Amir, Mayo Clinic, Rochester, Minnesota, United States
  • Textor, Stephen C., Mayo Clinic, Rochester, Minnesota, United States
  • Lerman, Lilach O., Mayo Clinic, Rochester, Minnesota, United States
Background

Hyperuricemia is associated with elevated risk for hypertension and chronic renal disease. PTRA improves blood pressure (BP) and renal function only in selected patients with atherosclerotic renovascular disease (ARVD), likely due to post-stenotic kidney injury. We hypothesized that hyperuricemia contributes to poor BP and renal functional outcomes in ARVD after PTRA.

Methods

Outcomes were compared among ARVD patients stratified by elevated serum uric acid (SUA) levels (>6.0mg/dl in women; >7.0mg/dl in men) undergoing PTRA. Multivariate analysis was used to determine significant predictors for renal and BP outcomes after PTRA.

Results

In 94 patients with ARVD studied retrospectively, pre-PTRA eGFR was lower in hyperuricemic compared with normouricemic patients, and remained lower after PTRA (Table), after adjustment for body-mass index, number of antihypertensive drugs, baseline eGFR, diuretic use, and left ventricular (LV) mass (p<0.05). PTRA did not affect eGFR in either group, while diastolic BP decreased in both. In univariate analysis, lower SUA was associated with improved BP after PTRA (Hazard ratio 0.84, p<0.05), but multivariate analysis revealed that only age, coexisting cerebrovascular disease, and number of antihypertensive drugs remained independent predictors. Contrarily, in multivariate linear analysis SUA independently predicted post-PTRA proteinuria (odds ratio 68.5, p<0.05, Figure A) after adjustment for pre-PTRA proteinuria, LV ejection fraction, and eGFR, and for cerebrovascular, peripheral, and cardiovascular disease. In 11 additional ARVD patients studied prospectively under controlled sodium intake and antihypertensive regimens, PTRA improved renal function (Figure B) only in patients with normal SUA (n=6, p<0.05).

Conclusion

Hyperuricemia does not aggravate BP outcomes in ARVD patients, but may be associated with greater renal dysfunction and proteinuria after PTRA. Thus, SUA in patients with ARVD might be a predictor of worse outcomes after PTRA.

Funding

  • Other NIH Support