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Kidney Week

Abstract: PO2102

Percutaneous Angioplasty of Renal Artery Stenosis Most Beneficial in Patients with AKI Requiring Acute Hemodialysis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Abu amer, Nabil Hassan, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
  • Kukuy, Lesya, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
  • Rimon, Uri, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
  • Holtzman, Eliezer J., Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
  • Beckerman, Pazit, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
  • Dinour, Dganit, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
Background

Treatment of atherosclerotic renal artery stenosis (RAS) is still contraversial and several studies have shown that percutaneous transluminal renal angioplasty with stenting (PTRAS) is not superior to medical treatment, and the procedure is commonly reserved for malignant hypertension, flash pulmonary edema or deterioration of kidney function. The benefit of endovascular intervention among acute kidney injury (AKI) patients requiring hemodialysis secondary to severe RAS has not been studied. We studied the effects of PTRAS in patients with atherosclerotic RAS, specifically those who presented with AKI indicated for hemodialysis.

Methods

109 PTRAS were performed in 92 patients with RAS from 2003 to 2019 in a tertiary hospital. Eleven patients presented with AKI secondary to high grade RAS and underwent PTRAS after starting acute hemodialysis. Data collected included demographic parameters, medical background, indication for intervention, technical procedure parameters and complications and long term data including dialysis treatment and mortality. Patients were categorized as responders or non-responders based on improvement in kidney function and discontinuation of dialysis.

Results

A total of 109 procedures were performed in 92 patients with severe renal artery stenosis. Eleven patients (12%) underwent PTRAS for severe high grade stenosis causing renal hypoperfusion and hemodialysis-dependent AKI. After PTRAS, 8 of 11 patients (73%) improved kidney function and discontinued dialysis. The average time on dialysis was 17 days (range 3-35 days) to PTRAS and 22 days (range 3-42 days) to recovery of kidney function, which occurred 6.5 days (range 1-24 days) after PTRAS. Two of the 8 patients later required long term hemodialysis. Only two cases were reported with mild complications.

Conclusion

In patients with hemodialysis dependent AKI, PTRAS should be considered as a rescue treatment as kidney function may recover even after prolonged time on dialysis.