NephrologyNow The Ultimate Guide to Kidney Disease Research

This is commentary on the ASTRAL study (Revascularization versus medical therapy for renal artery stenosis. N Engl J Med. 2009;361(20):1953-1962.) discusses trial findings, limitations and implications for practice.

This review discusses the implications of the STAR and ASTRAL studies on management of atherosclerotic renovascular disease and highlight an important study in progress, CORAL.   The authors summarize that “until completion of the CORAL study, it is prudent to restrict the endovascular intervention to only patients with tight RAS of the single functioning kidney or [...]

This randomized, non-blinded study of patients with renovascular disease compared renal artery revascularization plus medical therapy vs medical therapy alone.  Those in the revascularization arm experience an increased rate of serious complications with no reduction in pre-defined clinical endpoints.

140 patients were randomized to determine the efficacy and safety of stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function. The study concluded that stent placement with medical treatment had no clear effect on progression of renal dysfunction and, therefore, favored a conservative approach with cardiovascular risk factor management without stenting.