Impact of chronic kidney disease stage and distribution of renal artery stenosis on renal functional prognosis after revascularization in patients with renovascular hypertension

Abstract Background While the efficacy of revascularization for renovascular hypertension remains controversial in some patient groups, there are few reports on the impact of stage of chronic kidney disease (CKD) and distribution of renal artery stenosis on the prognosis of renal function after revascularization. Purpose To investigate the functional prognosis of renal function after revascularization for unilateral or bilateral renal artery stenosis based on pretreatment stage of CKD. Methods Patients with renovascular hypertension with unilateral or bilateral renal artery stenosis were included. Patients who underwent successful revascularization were analyzed retrospectively. Pretreatment renal function was classified into two groups using CKD stage between G3a and G3b based on estimated glomerular filtration rate (eGFR): higher-stage CKD (HS-CKD, eGFR44 mL/min/1.73m²) and lower-stage CKD (LS-CKD, eGFR≤44 mL/min/1.73m²). The subtraction in eGFR between pretreatment and 1 month after treatment was defined as delta eGFR. Delta eGFR was compared between treatment groups for unilateral stenosis (US) and bilateral stenosis (BS). Patients were included for BR only if complete revascularization was performed in one session. Results A total of 32 patients (20 males, mean age 73.2 ± 12.0 years) were analyzed. All patients were performed the procedure under the guidance of intravascular ultrasound and stent implantation with range from 4 to 6 mm of stent diameter. Overall, delta eGFR was significantly less in LS-CKD (n=20) compared to HS-CKD group (n=13) (0.5 -4.75-7.25 vs 15.5 3.25-24.0 mL/min/1.73m², P0.04). Comparing bilateral and unilateral lesions, post-treatment delta eGFR was similar between the UR (n=19) and BR (13) groups (4.00 -5.00 - 12.0 vs 5.00 -1.00-19.0 mL/min/1.73m², P=0. 23). In the UR group, there was no significant difference in delta eGFR between HS-CKD (n=7) and LS-CKD (n=12). (1.00 -5.75-9.50 vs. 5.00 -3.00-18.0 mL/min/1.73m², P=0.14). On the other hand, in the BS group, LS-CKD (n=8) had a significantly lower delta eGFR after revascularization compared to HS-CKD (n=5) (0.50 -2.75-7.25 vs 21.0 10.0-29.5 mL/min/1.73m², P=0.01). Conclusion The prognosis of renal function after revascularization for renal artery stenosis is potentially related not only to pre-treatment renal function, but also to the distribution of lesions, especially in patients with CKD 3b and below.