Insufficient Evidence to Choose Best Management of Renal Artery Stenosis

By Reuters Staff

August 18, 2016

NEW YORK (Reuters Health) - There is insufficient evidence to choose between percutaneous transluminal renal angioplasty with stent placement (PTRAS) and medical therapy alone for adults with atherosclerotic renal artery stenosis (ARAS), according to findings of an updated systematic review.

Although PTRAS is the current standard for revascularization of patients with ARAS, a 2007 systematic review concluded that evidence did not support one treatment approach over another in these patients.

Dr. Ethan M. Balk from Brown University School of Public Health in Providence, Rhode Island, and colleagues reevaluated the comparative benefits and harms of strategies for management of patients with ARAS in their systematic review of 15 studies that compared PTRAS with medical therapy.

They found low-strength evidence of no difference in mortality, progression to end-stage renal disease, cardiovascular disease event rates, or blood pressure control between PTRAS and medical therapy, although none of the studies was powered to detect these differences.

There was some low-strength evidence suggesting that kidney function may be improved in patients who undergo PTRAS, but this conclusion was based primarily on nonrandomized comparative studies, the researchers report in Annals of Internal Medicine, online August 16.

Adverse events were inconsistently defined and reported across studies.

The studies did not provide adequate evidence that any baseline characteristic would consistently predict post-PTRAS outcomes, the researchers say.

"Overall, the evidence does not support a benefit with PTRAS over medical therapy alone in most patients with ARAS," they conclude. "Observational studies, however, suggest that 'high-risk' patients - specifically, those with worse kidney function (variably defined), higher blood pressure (variably defined), or flash pulmonary edema - may be more likely to have improved kidney function and blood pressure with PTRAS."

"Reanalyses of existing databases or future large observational data sets using propensity score-adjusted or similar analyses may allow for relatively unbiased analyses to determine the comparative effectiveness of PTRAS and medical therapy," they add.

The analysis was funded by the Agency for Healthcare Research and Quality.

Dr. Balk did not respond to a request for comments.


Ann Intern Med 2016.