Simple clinical scores to predict blood pressure and renal function response to renal artery stenting for atherosclerotic renal artery stenosis.

INTRODUCTION No systematic tools exist to predict blood pressure (BP) or renal function (RF) improvement after stent-assisted angioplasty (PTA) for atherosclerotic renal artery stenosis (ARAS). OBJECTIVE To develop simple, clinically-applicable scores based on preprocedural clinical and renal ultrasonography parameters to predict BP and RF improvement following ARAS-PTA. PATIENTS AND METHODS 202 patients who underwent ARAS-PTA were categorized as RF responders (eGFR increase ≥11ml/min/1.73m2) or BP responders (systolic and diastolic BP decrease ≥20 and ≥5mmHg, respectively) at 12 months following ARAS-PTA. The variables associated with RF or BP response in univariable analysis were included in a multivariable logistic regression model. Point-based response scales were developed proportionally to the odds ratio values in each of two models to have the maximum score of 10. RESULTS The BP response to ARAS-PTA was 93.3% in the high-probability category (6-10 points), 66.7% in the intermediate-probability category (3-5 points), and 25.3% in the low-probability category (0-2 points), with the preprocedural variables of systolic BP ≥145mmHg (3 points), diastolic BP ≥83mmHg (4 points), PTA for a single functional kidney (2 points), and bilateral PTA (1 point). The RF response was 77.3% in the high-probability category (8-10 points), 33% in the intermediate-probability category (4-7 points), and 10.9% in the low-probability category (0-3 points) for serum creatinine >122µmol/L and eGFR >30ml/min/1.73m2 (3 points), index kidney length >98mm (3 points), renal artery end-diastolic velocity >1.1m/s (2 points), and arterial Resistive Index <0.74 (2 points). CONCLUSIONS BP and RF favorable response models, may enhance patient selection for ARAS-PTA. Further insights are expected from prospective validation.