Impact of Renal Artery Stent Implantation on Hypertension in Patients with Hemodialysis

Abstract

The benefit from renal artery stent implantation to treat atherosclerotic renal artery stenosis (ARAS) is not well understood in hemodialysis patients. We sought to evaluate the effects of renal artery stenting on hypertension of hemodialysis patients. Renal artery stent implantation was successfully performed on eight hypertensive hemodialysis patients with ARAS (mean ± SD, 66 ± 10 years; men 6, women 2). Blood pressure was measured by automated oscillometric recordings just before hemodialysis. Mean values of the blood pressure, measured 12 times a month, were used for blood pressure analysis. Values of systolic blood pressure decreased at 6 months after renal artery stent implantation (162.6 ± 29.7 to 121.1 ± 23.3 mm Hg, p = 0.0015). Values of diastolic blood pressure also decreased from 77.6 ± 13.6 to 65.6 ± 7.2 mm Hg (p = 0.02). Renal artery stent implantation for ARAS had a beneficial effect on hypertension in hemodialysis patients.

Keywords

atherosclerotic renal artery stenosis - renal artery stent implantation - hypertension - hemodialysis - blood pressure

• References

• 1 Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med 2001; 344 (6) 431-442
• 2 Dorros G, Jaff M, Mathiak L , et al. Four-year follow-up of Palmaz-Schatz stent revascularization as treatment for atherosclerotic renal artery stenosis. Circulation 1998; 98 (7) 642-647
• 3 Bax L, Woittiez AJJ, Kouwenberg HJ , et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med 2009; 150 (12) 840-848 , W150-1
• 4 Wheatley K, Ives N, Gray R , et al; ASTRAL Investigators. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009; 361 (20) 1953-1962
• 5 Rocha-Singh KJ, Novack V, Pencina M , et al. Objective performance goals of safety and blood pressure efficacy for clinical trials of renal artery bare metal stents in hypertensive patients with atherosclerotic renal artery stenosis. Catheter Cardiovasc Interv 2011; 78 (5) 779-789
• 6 Jaff MR, Bates M, Sullivan T , et al; HERCULES Investigators. Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: results from the HERCULES trial. Catheter Cardiovasc Interv 2012; 80 (3) 343-350
• 7 Miyashita Y, Ikeda U, Soga Y, Yokoi H, Suzuki K, Inoue N. Results of the retrospective analysis of renal artery stenting for the salvage of renal function study. Angiology 2013;
• 8 Mangiacapra F, Trana C, Sarno G , et al. Translesional pressure gradients to predict blood pressure response after renal artery stenting in patients with renovascular hypertension. Circ Cardiovasc Interv 2010; 3 (6) 537-542
• 9 Mahmud E, Smith TWR, Palakodeti V , et al. Renal frame count and renal blush grade: quantitative measures that predict the success of renal stenting in hypertensive patients with renal artery stenosis. JACC Cardiovasc Interv 2008; 1 (3) 286-292
• 10 Mailloux LU, Napolitano B, Bellucci AG, Vernace M, Wilkes BM, Mossey RT. Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience. Am J Kidney Dis 1994; 24 (4) 622-629
• 11 Thatipelli M, Misra S, Johnson CM , et al. Renal artery stent placement for restoration of renal function in hemodialysis recipients with renal artery stenosis. J Vasc Interv Radiol 2008; 19 (11) 1563-1568
• 12 Blankestijn PJ, Ligtenberg G. Volume-independent mechanisms of hypertension in hemodialysis patients: clinical implications. Semin Dial 2004; 17 (4) 265-269
• 13 Morishita Y, Kusano E. The blockade of renin-angiotensin-aldosterone system in hemodialysis patients to control hypertension and prevent cardiovascular disease: optimal pharmacotherapy. Cardiovasc Hematol Agents Med Chem 2011; 9 (4) 241-246
• 14 Grekas D, Bamichas G, Bacharaki D, Goutzaridis N, Kasimatis E, Tourkantonis A. Hypertension in chronic hemodialysis patients: current view on pathophysiology and treatment. Clin Nephrol 2000; 53 (3) 164-168