Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review.
| Title: | Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review. |
|---|---|
| Authors: | Raman G; From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.; Adam GP; From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.; Halladay CW; From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.; Langberg VN; From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.; Azodo IA; From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.; Balk EM; From Tufts Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, Massachusetts; Center for Evidence-based Medicine, Brown University, Providence, Rhode Island; and College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom. |
| Source: | Annals of internal medicine [Ann Intern Med] 2016 Nov 01; Vol. 165 (9), pp. 635-649. Date of Electronic Publication: 2016 Aug 16. |
| Publication Type: | Journal Article; Systematic Review |
| Language: | English |
| Journal Info: | Publisher: American College of Physicians--American Society of Internal Medicine Country of Publication: United States NLM ID: 0372351 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-3704 (Electronic) Linking ISSN: 00034819 NLM ISO Abbreviation: Ann Intern Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: : Philadelphia, PA : American College of Physicians--American Society of Internal Medicine; Original Publication: Philadelphia [etc.] American College of Physicians. |
| MeSH Terms: | Renal Artery Obstruction/*therapy; Angioplasty/methods ; Antihypertensive Agents/therapeutic use ; Hypertension/drug therapy ; Hypertension/etiology ; Renal Artery Obstruction/complications ; Renal Artery Obstruction/drug therapy ; Renal Artery Obstruction/mortality ; Renal Insufficiency/etiology ; Renal Insufficiency/therapy ; Adult ; Comparative Effectiveness Research ; Humans ; Stents |
| Abstract: | Background: Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death.; Purpose: To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS.; Data Sources: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews.; Study Selection: Randomized, controlled trials (RCTs); nonrandomized, comparative studies (NRCSs); single-group studies; and selected case reports that reported all-cause and cardiovascular mortality, RRT, kidney function, BP, and adverse events.; Data Extraction: Six researchers extracted data on design, interventions, outcomes, and study quality into a Web-based database.; Data Synthesis: Eighty-three studies met eligibility criteria. In 5 of 7 RCTs, PTRAS and medical therapy led to similar BP control in patients with ARAS, and no RCTs showed statistically significant differences in kidney function, mortality, RRT, cardiovascular events, or pulmonary edema. Eight NRCSs had more variable results, finding mostly no significant differences in mortality, RRT, or cardiovascular events but heterogeneous effects on kidney function and BP. Procedure-related adverse events were rare, and medication-related adverse events were not reported. Two RCTs found no patient characteristics that were associated with outcomes with either PTRAS or medical therapy. Single-group studies found various but inconsistent factors that predict outcomes. Case reports provided examples of clinical improvement after PTRAS in patients with acute decompensation.; Limitation: Limited clinical applicability and power in RCTs, and possible publication bias and lack of adjusted analyses in NRCSs.; Conclusion: The strength of evidence regarding the relative benefits and harms of PTRAS versus medical therapy alone for patients with ARAS is low. Studies have generally focused on patients with less severe ARAS.; Primary Funding Source: Agency for Healthcare Research and Quality. |
| Comments: | Comment in: Ann Intern Med. 2016 Dec 20;165(12):JC71. doi: 10.7326/ACPJC-2016-165-12-071.. (PMID: 27992927); Comment in: Am J Kidney Dis. 2017 Aug;70(2):160-163. doi: 10.1053/j.ajkd.2017.04.013.. (PMID: 28535904) |
| Substance Nomenclature: | 0 (Antihypertensive Agents) |
| Entry Date(s): | Date Created: 20160819 Date Completed: 20170512 Latest Revision: 20250626 |
| Update Code: | 20260130 |
| DOI: | 10.7326/M16-1053 |
| PMID: | 27536808 |
| Database: | MEDLINE |
Journal Article; Systematic Review