December 12, 2008

Impact Of Metabolic Syndrome On The Outcomes Of Percutaneous Renal Angioplasty And Stenting

Mark G. Davies, MD PhD MBA, Jean X. Bismuth, MD, Joseph J. Naoum, MD, Imran T. Mouhiddin, MD, Eric K. Peden, MD, Alan B. Lumsden, MD.
Methodist Debakey Heart and Vascular Center, Houston, TX, USA.

Background:Endovascular therapy for symptomatic atherosclerotic renal artery stenosis (ARAS) is common and effective in the well-selected patient. Hypertension is a common indication for intervention and a major component of metabolic syndrome (MetS). The impact of MetS on outcomes after percutaneous renal intervention is unknown.
Methods: We performed a retrospective analysis of records from patients who underwent endovascular intervention for ARAS and were followed by duplex ultrasound between January 1990 and Jan 2008. MetS was defined as the presence of >3 of the following criteria: Blood pressure ≥130mmHg/≥80mmHg; Triglycerides>150mg/dl; HDL<50mg/dl for women and <40mg/dl for men; Fasting blood glucose >110mg/dl; or Body Mass Index >30kg/m². The average follow-up period was 5 years. Clinical benefit defined as freedom from renal-related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from renal-related causes), anatomic patency, restenosis and patient survival were measured.
Results: 592 renal artery interventions were performed in 459 patients (57% male, average age 70 yrs. 52% were identified as having MetS. Patients with MetS were more often female (Table 1). There were no differences significant differences in presenting symptoms (Table 1). There was no peri-operative mortality and equivalent morbidity (7% vs. 6%, No MetS vs. MetS). Patients with metabolic syndrome have a decreased survival and have a lower freedom from restenosis and lower retained clinical benefit with a higher number progressing to hemodialysis. (Table 1). Individually, the components of MetS did not influence outcomes. Statin therapy did not influence outcomes.



Table 1	No MetS	MetS	p-value
Patients	282	310	-
Gender (% male)	67	47	0.05
Age (years) *	70±1	71±2	ns
Hypertension (% of n)	60	58	ns
Elevated Creatinine >1.5 mg/dl (% of n)	12	10	ns
Hypertension & Elevated Creatinine (% of n)	28	32	ns
Survival (% alive) *	41±3	30±5	0.05
Cumulative Patency (% patent) *	85±6	82±7	ns
Restenosis (% free) *	87±2	69±9	0.01
Clinical Benefit (% retained) *	71±8	45±8	0.01
Progression to Hemodialysis (% of n)	4	18	0.01

*Mean±SEM at ten years follow up
Conclusion: Metabolic syndrome is associated with markedly reduced renal clinical benefit lower survival and increased progression to hemodialysis. MetS should be considered a risk factor for poor long-term outcomes following renal interventions and interventions to modulate its components should be considered at the time of presentation.

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