Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Lyon 1 Claude Bernard University, Villeurbanne, France.
PLoS One. 2019 Jun 24;14(6):e0218788. doi: 10.1371/journal.pone.0218788. eCollection 2019.
In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital.
To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization.
Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity >180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected.
Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23±34mmHg, p = 0.007), diastolic blood pressure (-12±18mmHg, p = 0.007), number of antihypertensive medications (-1.00±1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event.
Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.
在动脉粥样硬化性肾血管疾病中，血运重建的获益存在争议。在里昂大学附属医院，通过多学科会议制定了一种临床决策流程。
研究该决策流程是否为接受肾血运重建的患者带来了临床获益。
这是一项单中心回顾性队列研究，纳入了 2013 年 4 月至 2015 年 2 月期间诊断为峰值收缩期速度＞180cm/s 的动脉粥样硬化性肾血管疾病患者。对于每例患者，在多学科会议上做出的决策（药物治疗或血运重建）与国际指南指导下的决策进行比较。比较了患者在 1 年随访时的血压值、降压药物数量、未控制或耐药性高血压的存在情况以及肾小球滤过率与基线值的差异。收集了安全性数据。
共纳入 49 例患者：26 例（53%）接受药物治疗，23 例（47%）接受肾血运重建。治疗决策与 2013 年美国心脏协会指南和 2017 年欧洲心脏病学会指南一致，分别有 78%和 22%的接受血运重建的患者符合这两个指南。接受血运重建的患者收缩压（-23±34mmHg，p=0.007）、舒张压（-12±18mmHg，p=0.007）、降压药物数量（-1.00±1.03，p=0.001）和未控制或耐药性高血压的数量（p=0.022 和 0.031）在 1 年随访时显著下降。单独接受药物治疗的患者这些参数没有改变。没有 3 级不良事件。
基于多学科选择血运重建适应证，接受肾血运重建的患者血压控制参数显著改善，且无严重不良事件。
