动脉粥样硬化性肾血管疾病肾动脉支架置入术后的死亡率和肾脏替代治疗
Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease.
作者信息
Misra Sanjay, Khosla Ankaj, Allred Jake, Harmsen William S, Textor Stephen C, McKusick Michael A
机构信息
Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
出版信息
J Vasc Interv Radiol. 2016 Aug;27(8):1215-24. doi: 10.1016/j.jvir.2016.05.001. Epub 2016 Jun 11.
PURPOSE
To identify risk factors for progression to renal replacement therapy (RRT) and all-cause mortality in patients who underwent renal artery (RA) stent placement for atherosclerotic renal artery stenosis (RAS).
MATERIALS AND METHODS
A retrospective study from June 1996 to June 2009 identified 1,052 patients who underwent RA stent placement. Glomerular filtration rate at time of RA stent placement was estimated from serum creatinine level and divided into chronic kidney disease (CKD) stages 1-5. Univariate and multivariable Cox proportional hazards models were used to determine which factors were associated with each endpoint.
RESULTS
Times to progression to all-cause mortality and RRT were similar for CKD stages 1/2/3A and served as the reference group. In multivariable analysis, high-grade proteinuria (P < .001) and higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P < .001], 3B vs 1/2/3A [P = .02]) remained independently associated with increased risk of progression to RRT. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use was associated with decreased risk of progression to RRT (P = .03). Higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P = .004]), carotid artery disease (P < .001), diabetes mellitus (P = .002), and high-grade proteinuria (P < .001) remained independently associated with all-cause mortality. Statin use was associated with decreased risk of all-cause mortality (P < .001).
CONCLUSIONS
Patients with atherosclerotic RAS who undergo RA stent placement and have high-grade proteinuria and CKD stage 3B/4/5 have increased risk of progression to RRT. Patients with high-grade proteinuria, CKD stage 3B/4/5, carotid artery disease, or diabetes have increased risk for all-cause mortality after renal artery stent placement. Patients receiving ACEI/ARBs have a decreased risk of progression to RRT, and patients receiving statins have a decreased risk of all-cause mortality.
目的
确定因动脉粥样硬化性肾动脉狭窄（RAS）接受肾动脉（RA）支架置入术的患者进展至肾脏替代治疗（RRT）及全因死亡的危险因素。
材料与方法
一项回顾性研究纳入了1996年6月至2009年6月期间1052例行RA支架置入术的患者。根据血清肌酐水平估算RA支架置入时的肾小球滤过率，并分为慢性肾脏病（CKD）1 - 5期。采用单因素和多因素Cox比例风险模型来确定哪些因素与各终点相关。
结果
CKD 1/2/3A期进展至全因死亡和RRT的时间相似，并作为参照组。多因素分析中，重度蛋白尿（P < 0.001）和更高的CKD分期（5期对比1/2/3A期[P < 0.001]，4期对比1/2/3A期[P < 0.001]，3B期对比1/2/3A期[P = 0.02]）仍然与进展至RRT的风险增加独立相关。使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）与进展至RRT的风险降低相关（P = 0.03）。更高的CKD分期（5期对比1/2/3A期[P < 0.001]，四期对比1/2/3A期[P = 0.004]）、颈动脉疾病（P < 0.001）、糖尿病（P = 0.002）和重度蛋白尿（P < 0.001）仍然与全因死亡独立相关。使用他汀类药物与全因死亡风险降低相关（P < 0.001）。
结论
因动脉粥样硬化性RAS接受RA支架置入术且有重度蛋白尿和CKD 3B/4/5期的患者进展至RRT的风险增加。有重度蛋白尿、CKD 3B/4/5期、颈动脉疾病或糖尿病的患者在肾动脉支架置入术后全因死亡风险增加。接受ACEI/ARB治疗的患者进展至RRT的风险降低，接受他汀类药物治疗的患者全因死亡风险降低。
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