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No evidence angioplasty superior to medical therapy in renal artery stenosis
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Among patients with atherosclerotic renal artery stenosis, the strength of evidence for the relative benefits and harms of percutaneous transluminal renal angioplasty with stent placement vs. medical therapy alone is low, according to a study published in the Annals of Internal Medicine.
Gowri Raman, MD, from Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, and colleagues conducted a systematic literature review to compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) vs. medical therapy alone in adults with atherosclerotic renal artery stenosis (ARAS). Eighty-three studies meeting the eligibility criteria, including seven randomized controlled trials, yielded measurable data.
Gowri Raman
The researchers sought to compare the benefits and harms of PTRAS against medical therapy alone in adults with ARAS. They analyzed data from Medline, Embase and Cochrane Central Register of Controlled Trials from 1993 to 2016.
In five of seven randomized controlled trials, researchers found that there was similar BP control with PTRAS and medical therapy in patients with ARAS. They also found no significant differences in kidney function, mortality, renal replacement therapy, CV events or pulmonary edema in any of the randomized controlled trials.
More variable results were seen in eight nonrandomized comparative trials, mostly showing no significant differences in mortality, renal replacement therapy or CV events. However, heterogeneous effects were seen on kidney function and BP. Adverse events related to procedure were rare, and there were no reports of medication-related adverse events.
No patient characteristics associated with outcomes for PTRAS or medical therapy were found in two randomized controlled trials; various but inconsistent factors that predict outcomes were identified in single-group studies.
“The strength of evidence regarding the relative benefits and harms of PTRAS vs. medical therapy alone for patients with ARAS is low,” the authors wrote. “[Overall], the evidence does not support a benefit with PTRAS over medical therapy alone in most patients with ARAS.” – by James Clark
Disclosure: Raman and one other researcher report receiving grants from the Agency for Healthcare Research and Quality during the study.
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