ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1807

Long-Term Outcomes After Renal Revascularization for Atherosclerotic Renovascular Disease in the ASTRAL Trial

Session Information

Category: Hypertension and CVD

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

Authors

  • Kalra, Philip A., Salford Royal Hospital, Salford, Salford, United Kingdom
  • Green, Darren, Salford Royal Hospital, Salford, Salford, United Kingdom
  • Ives, Natalie, University of Birmingham, Birmingham, Birmingham, United Kingdom

Group or Team Name

  • The ASTRAL trial investigators
Background

The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial recruited 806 patients with atherosclerotic renal artery stenosis (RAS) between 2000-2007, randomised 1:1 to medical therapy with or without renal artery stenting. The initial results were presented in 2009 at median follow-up 34.6 months when no benefit of revascularization to renal functional outcome or cardiovascular events (CVE) were evident. Surviving patients remained under follow up until 2014.

Methods

All available data were analysed to assess whether there was a later impact of revascularization on renal function, CVE and survival, including a composite outcome of renal and CV outcomes and death (as used in the CORAL trial). Pre-specified sub-group analyses of different categories of renal function, renal length, prior rapid deterioration in kidney function, and severity of RAS. Further post-hoc analysis of patients with severe RAS (defined as bilateral 70% or > 70% RAS in a solitary kidney = global renal ischemia), those with/without proteinuria and a per protocol analysis were performed.

Results

The mean age of the entry population was 70.5 years, mean eGFR 40 ml/min/1.73m2, with mean RAS 76% and blood pressure 150/76 mmHg; 83% of the revascularization group underwent attempted stenting. Median follow-up was 56.4 months with 108 patients lost to follow up or withdrawn; 50% of the evaluable population had died, 14% had received RRT and 40% had suffered a 1st CVE. No benefit of revascularization was observed for any outcome in the intention to treat and per protocol analyses, either in the whole population or the pre-specified sub-groups. In the severe RAS sub-group (163 patients) revascularization was associated with a hazard ratio (HR) of 0.74 (0.54-1.01; p=0.062) for the composite renal and CV outcome and an HR of 0.70 (0.49-1.0) for death (p=0.051).

Conclusion

The long-term follow-up of the ASTRAL trial population showed no overall benefit of renal revascularization to renal and CV outcomes. It has been highlighted that a proportion of the population had lower risk mild-moderate RAS. The long-term outcomes in patients with severe RAS (global renal ischemia) point to a potential benefit of stenting that may be worthy of further study in a more selected population.

Funding

  • Government Support – Non-U.S.