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Previous Volume 344:410-417 February 8, 2001 Number 6 Next

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ABSTRACT

Background Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance to flow in the segmental arteries of both kidneys (indicated by resistance-index values of at least 80) can be used prospectively to select appropriate patients for treatment.

Methods We evaluated 5950 patients with hypertension for renal-artery stenosis using color Doppler ultrasonography, and we measured the resistance index as follows: [1 – (end-diastolic velocity ÷ maximal systolic velocity)] x 100. Among 138 patients who had unilateral or bilateral renal-artery stenosis of more than 50 percent of the luminal diameter and who underwent renal angioplasty or surgery, the procedure was technically successful in 131 (95 percent). Creatinine clearance and 24-hour ambulatory blood pressure were measured before renal-artery stenosis was corrected; 3, 6, and 12 months after the procedure; and yearly thereafter. The mean (±SD) duration of follow-up was 32±21 months.

Results Among the 35 patients (27 percent) who had resistance-index values of at least 80 before revascularization, the mean arterial pressure did not decrease by 10 mm Hg or more after revascularization in 34 (97 percent). Renal function declined (defined by a decrease in the creatinine clearance of at least 10 percent) in 28 (80 percent); 16 (46 percent) became dependent on dialysis; and 10 (29 percent) died during follow-up. Among the 96 patients (73 percent) with a resistance-index value of less than 80, the mean arterial pressure decreased by at least 10 percent in all but 6 patients (6 percent) after revascularization; renal function worsened in only 3 (3 percent), all of whom became dependent on dialysis; and 3 (3 percent) died (P<0.001 for the comparison with patients with a resistance-index value of at least 80).

Conclusions A renal resistance-index value of at least 80 reliably identifies patients with renal-artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival.

Source Information

From the Departments of Nephrology (J.R., A.V., B.S., K.M.K., H.H.), Radiology (A.C., M.G.), and Gastroenterology (J.B., M.J.G.), Medizinische Hochschule Hannover, Hannover, Germany.

Address reprint requests to Dr. Radermacher at the Department of Nephrology, Medizinische Hochschule Hannover, P.O. Box 61 01 80, D-30625 Hannover, Germany, or at radermacher.joerg{at}mh-hannover.de.

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