Long-term outcome of surgical revascularization in ischemic nephropathy: normalization of average decline in renal function Cornelis J. van Rooden, MD,

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Presentation transcript:

Long-term outcome of surgical revascularization in ischemic nephropathy: normalization of average decline in renal function Cornelis J. van Rooden, MD, J.Hajo van Bockel, MD, PhD, Guy G. De Backer, MD, PhD, Jo Hermans, PhD, Peter C. Chang, MD, PhD Journal of Vascular Surgery Volume 29, Issue 6, Pages 1037-1049 (June 1999) DOI: 10.1016/S0741-5214(99)70245-4 Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig 1 Enrollment of patients with renovascular hypertension (RVH) and ischemic nephropathy (serum creatinine level, 150 mmol/L before surgery). Estimated glomerular filtration rate used Cockcroft and Gault method22 and was corrected for body surface area. PO, Postoperative follow-up examination; ST, short-term follow-up examination (on average, 8 months after surgery); LT, long-term follow-up examination (on average, 47 months after surgery). Journal of Vascular Surgery 1999 29, 1037-1049DOI: (10.1016/S0741-5214(99)70245-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig 2 Course of estimated glomerular filtration rate (EGFR) in the general population. 16,17 A, Patients were men (n = 5657). B, Patients were women (n = 4657). Nonlinear regression analysis yielded best fits with depicted second order polynomial functions. Journal of Vascular Surgery 1999 29, 1037-1049DOI: (10.1016/S0741-5214(99)70245-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig 3 Course of estimated glomerular filtration rate (EGFR) between short-term (average, 8 months after surgery) and long-term (average, 47 months after surgery) follow-up examinations in all 37 patients with atherosclerotic renovascular disease. Continuous lines represent men, and dashed lines represent women. Upper two curves represent estimated course of EGFR in the general population (Fig 2). Journal of Vascular Surgery 1999 29, 1037-1049DOI: (10.1016/S0741-5214(99)70245-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig 4 Typical example of analysis, in male patient, of effect of revascularization on renal function decline. Decline in renal function in male control population16,17 is depicted by thick-line curve (Fig 2A). From before surgery until short-term ( ST; in this case, 8 months after surgery) follow-up visit, estimated glomerular filtration rate (EGFR)22 improved significantly. Decline in renal function between short-term and long-term (LT; in this case, 90 months later) follow-up visit is depicted by slope (–0.8 mL/min/1.73 m2/year) of line connecting short-term and long-term points. In control population, decline over same interval (arrows ) is depicted by line c (–1.1 mL/min/1.73 m2/year). Preoperative decline in renal function (assuming that patient had a normal renal function at age of 25 years) is arbitrarily chosen as line connecting EGFR at 25 years of age in normal male control population and EGFR before surgery (short-dashed line; –2.1 mL/min/1.73 m2/year). Self evidently, actual preoperative course of renal function in a patient is, in fact, unknown and more likely first follows normal population curve and, in the last years before revascularization, shows a more rapid decline when renal artery stenoses or hypertensive renal damage becomes critical (for example, as depicted by curve a). Journal of Vascular Surgery 1999 29, 1037-1049DOI: (10.1016/S0741-5214(99)70245-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig 5 Slope of estimated glomerular filtration rate (EGFR; weighted means with interquartile ranges) before (open bar) and after operation (hatched bar; P < .01 vs before operation) and in a control population (black bar). With assumption of normal renal function at age 25 years, preoperative slope of EGFR in each patient was arbitrarily defined as slope between EGFR in sex-matched control population at 25 years and patient's preoperative EGFR. Long-term slope of EGFR after operation was calculated for each of the 37 patients as slope between each individual's EGFR at short-term and long-term follow-up visits. Slope in the control population was derived by taking for each patient at short-term and at long-term follow-up visits EGFR in age-matched and sex-matched control population. Journal of Vascular Surgery 1999 29, 1037-1049DOI: (10.1016/S0741-5214(99)70245-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions