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  1. Article ; Online: The utility of myocardial perfusion imaging before renal transplantation: a retrospective analysis.

    Callan, Paul D / Bhandari, Sunil / Clark, Andrew L / Eadington, David / Papadopoulos, Emmanouil / Tweddel, Ann C

    Nuclear medicine communications

    2018  Volume 39, Issue 3, Page(s) 228–235

    Abstract: Background: Renal transplantation (RT) reduces morbidity and mortality in patients with end-stage renal failure. Myocardial perfusion imaging provides prognostic information in patients with renal failure, but its role before transplantation remains ... ...

    Abstract Background: Renal transplantation (RT) reduces morbidity and mortality in patients with end-stage renal failure. Myocardial perfusion imaging provides prognostic information in patients with renal failure, but its role before transplantation remains unclear. We performed a retrospective review assessing the prognostic value of technetium-99m sestamibi myocardial perfusion imaging at a tertiary UK centre.
    Patients and methods: We included scans performed between 2005 and 2012. Available scans were reanalysed to calculate the semiquantitative summed scores: sum rest score (SRS), sum stress score (SSS), sum difference score and sum motion score (SMS). Kaplan-Meier survival estimates assessed all-cause mortality and cardiac events according to scan findings, transplant decision and SSS. Cox-proportional hazards tested for an association between clinical/scan variables and all-cause mortality, and combined all-cause mortality/cardiovascular (CV) events.
    Results: One hundred and thirty-eight scans were identified with complete follow-up. During a median 40.4-month follow-up, 21 patients died, with 11 nonfatal CV events. There was no significant difference between groups according to scan findings for mortality (log-rank P=0.17) or mortality/CV events (P=0.06). An SSS greater than 8 was associated with higher mortality and CV events combined (P=0.028). An abnormal baseline ECG [hazard ratio (HR): 16.1] and higher SRS (HR: 2.3) were associated independently with higher mortality; an abnormal ECG (HR: 3.4) also predicted higher cardiac events/mortality.
    Conclusion: Moderate to severe perfusion defects by SSS were associated with higher mortality and CV events. Higher SRS was associated independently with increased mortality on multivariable analysis, highlighting a key role for semiquantitative analysis methods for risk stratification. An abnormal ECG was associated strongly with both endpoints, and may be a useful screening tool to select patients for further investigation.
    MeSH term(s) Female ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Myocardial Perfusion Imaging ; Retrospective Studies ; Stress, Physiological
    Language English
    Publishing date 2018-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 758141-5
    ISSN 1473-5628 ; 0143-3636
    ISSN (online) 1473-5628
    ISSN 0143-3636
    DOI 10.1097/MNM.0000000000000793
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Efficacy of renal artery angioplasty and stenting in a solitary functioning kidney.

    Tan, Jackson / Filobbos, Rafik / Raghunathan, Girish / Nicholson, Tony / Fowler, Richard / Wright, Mark / Eadington, David

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2007  Volume 22, Issue 7, Page(s) 1916–1919

    Abstract: Objective: The aim of this study was to share our experience of percutaneous renal artery angioplasty and stenting (PTRAS) in our patients with a solitary functioning kidney over a 10-year period.: Methods: The procedures were performed on 75 ... ...

    Abstract Objective: The aim of this study was to share our experience of percutaneous renal artery angioplasty and stenting (PTRAS) in our patients with a solitary functioning kidney over a 10-year period.
    Methods: The procedures were performed on 75 patients from 1995 to 2004. Data were collected retrospectively from case notes of patients. The definition for solitary functioning kidney was a contralateral kidney size of <8 cm, complete occlusion of contralateral renal artery or previous nephrectomy. Serum creatinine was considered improved or worse if the deviation from the baseline value was >20%.
    Results: For the purpose of halting renal deterioration (n=47), there were improvement and stabilization in 21% and 55% at 3 months and 28% and 28% at 12 months. Systolic blood pressure (n=27) improvement and stabilization were achieved in 33% and 56% both at 3 and 12 months. Diastolic blood pressure (n=27) improvement and stabilization were 22% and 70% at 3 months and 33% and 48% at 12 months. Five out of seven patients with acute renal failure (serum creatinine>500 micromol/l and requiring haemodialysis) pre-procedure were dialysis-free at 12 months. Complications occurred in 19 (25%) patients and these included bleeding (n=16), pseudoaneurysm (n=3), renal artery dissection (n=2) and cholesterol embolization (n=1).
    Conclusion: PTRAS in a solitary functioning kidney produced clinical benefits in the majority of patients with resistant hypertension and renal function deterioration.
    MeSH term(s) Acute Kidney Injury/etiology ; Acute Kidney Injury/physiopathology ; Aged ; Angioplasty/adverse effects ; Blood Pressure ; Diastole ; Humans ; Hypertension/etiology ; Hypertension/physiopathology ; Kidney/physiopathology ; Middle Aged ; Renal Artery ; Renal Artery Obstruction/complications ; Renal Artery Obstruction/mortality ; Renal Artery Obstruction/physiopathology ; Renal Artery Obstruction/therapy ; Retrospective Studies ; Stents/adverse effects ; Systole ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2007-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfm130
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    Zs.A 2198: Show issues Location:
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  3. Article ; Online: Effect of renal artery revascularization upon cardiac structure and function in atherosclerotic renal artery stenosis: cardiac magnetic resonance sub-study of the ASTRAL trial.

    Ritchie, James / Green, Darren / Chrysochou, Tina / Hegarty, Janet / Handley, Kelly / Ives, Natalie / Wheatley, Keith / Houston, Graeme / Wright, Julian / Neyses, Ludwig / Chalmers, Nicholas / Mark, Patrick / Patel, Rajan / Moss, Jon / Roditi, Giles / Eadington, David / Lukaschuk, Elena / Cleland, John / Kalra, Philip A

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2016  Volume 32, Issue 6, Page(s) 1006–1013

    Abstract: Background: Cardiac abnormalities are frequent in patients with atherosclerotic renovascular disease (ARVD). The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial studied the effect of percutaneous renal revascularization combined with ... ...

    Abstract Background: Cardiac abnormalities are frequent in patients with atherosclerotic renovascular disease (ARVD). The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial studied the effect of percutaneous renal revascularization combined with medical therapy compared with medical therapy alone in 806 patients with ARVD.
    Methods: This was a pre-specified sub-study of ASTRAL (clinical trials registration, current controlled trials number: ISRCTN59586944), designed to consider the effect of percutaneous renal artery angioplasty and stenting on change in cardiac structure and function, measured using cardiac magnetic resonance (CMR) imaging. Fifty-one patients were recruited from six selected ASTRAL centres. Forty-four completed the study (medical therapy n = 21; revascularization n = 23). Full analysis of CMR was possible in 40 patients (18 medical therapy and 22 revascularization). CMR measurements of left and right ventricular end systolic (LV and RVESV) and diastolic volume (LV and RVEDV), ejection fraction (LVEF) and mass (LVM) were made shortly after recruitment and before revascularization in the interventional group, and again after 12 months. Reporting was performed by CMR analysts blinded to randomization arm.
    Results: Groups were well matched for mean age (70 versus 72 years), blood pressure (148/71 versus 143/74 mmHg), degree of renal artery stenosis (75 versus 75%) and comorbid conditions. In both randomized groups, improvements in cardiac structural parameters were seen at 12 months, but there were no significant differences between treatment groups. Median left ventricular changes between baseline and 12 months (medical versus revascularization) were LVEDV -1.9 versus -5.8 mL, P = 0.4; LVESV -2.1 versus 0.3 mL, P = 0.7; LVM -5.4 versus -6.3 g, P = 0.8; and LVEF -1.5 versus -0.8%, P = 0.7. Multivariate regression also found that randomized treatment assignment was not associated with degree of change in any of the CMR measurements.
    Conclusions: In this sub-study of the ASTRAL trial, renal revascularization did not offer additional benefit to cardiac structure or function in unselected patients with ARVD.
    MeSH term(s) Aged ; Aged, 80 and over ; Angioplasty ; Atherosclerosis/physiopathology ; Atherosclerosis/surgery ; Blood Pressure ; Female ; Glomerular Filtration Rate ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/pathology ; Heart Ventricles/physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myocardium/pathology ; Renal Artery/surgery ; Renal Artery Obstruction/physiopathology ; Renal Artery Obstruction/surgery ; Treatment Outcome
    Language English
    Publishing date 2016-05-30
    Publishing country England
    Document type Clinical Trial ; Journal Article ; Multicenter Study
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfw107
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: 157 Renal artery stenosis

    Thackray Ann C / Thackray Simon / Eadington David / Nicoslon Tony / Lukaschuk Elena / de Silva Ramesh / Loh Huan P / Bourantas Christos V / Clark Andrew L / Nikitin Nikolay P / Cleland John GF

    Journal of Cardiovascular Magnetic Resonance, Vol 10, Iss Suppl 1, p A

    independent predictor of increased mortality in patients with heart failure. A Magnetic Resonance Imaging study

    2008  Volume 58

    Keywords Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2008-10-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Revascularization versus medical therapy for renal-artery stenosis.

    Wheatley, Keith / Ives, Natalie / Gray, Richard / Kalra, Philip A / Moss, Jonathan G / Baigent, Colin / Carr, Susan / Chalmers, Nicholas / Eadington, David / Hamilton, George / Lipkin, Graham / Nicholson, Anthony / Scoble, John

    The New England journal of medicine

    2009  Volume 361, Issue 20, Page(s) 1953–1962

    Abstract: Background: Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited.: Methods: In a randomized, unblinded trial, we assigned 806 patients with ... ...

    Abstract Background: Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited.
    Methods: In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic renovascular disease either to undergo revascularization in addition to receiving medical therapy or to receive medical therapy alone. The primary outcome was renal function, as measured by the reciprocal of the serum creatinine level (a measure that has a linear relationship with creatinine clearance). Secondary outcomes were blood pressure, the time to renal and major cardiovascular events, and mortality. The median follow-up was 34 months.
    Results: During a 5-year period, the rate of progression of renal impairment (as shown by the slope of the reciprocal of the serum creatinine level) was -0.07x10(-3) liters per micromole per year in the revascularization group, as compared with -0.13x10(-3) liters per micromole per year in the medical-therapy group, a difference favoring revascularization of 0.06x10(-3) liters per micromole per year (95% confidence interval [CI], -0.002 to 0.13; P=0.06). Over the same time, the mean serum creatinine level was 1.6 micromol per liter (95% CI, -8.4 to 5.2 [0.02 mg per deciliter; 95% CI, -0.10 to 0.06]) lower in the revascularization group than in the medical-therapy group. There was no significant between-group difference in systolic blood pressure; the decrease in diastolic blood pressure was smaller in the revascularization group than in the medical-therapy group. The two study groups had similar rates of renal events (hazard ratio in the revascularization group, 0.97; 95% CI, 0.67 to 1.40; P=0.88), major cardiovascular events (hazard ratio, 0.94; 95% CI, 0.75 to 1.19; P=0.61), and death (hazard ratio, 0.90; 95% CI, 0.69 to 1.18; P=0.46). Serious complications associated with revascularization occurred in 23 patients, including 2 deaths and 3 amputations of toes or limbs.
    Conclusions: We found substantial risks but no evidence of a worthwhile clinical benefit from revascularization in patients with atherosclerotic renovascular disease. (Current Controlled Trials number, ISRCTN59586944.)
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon/adverse effects ; Antihypertensive Agents/therapeutic use ; Blood Pressure ; Combined Modality Therapy ; Drug Therapy, Combination ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/therapeutic use ; Renal Artery Obstruction/drug therapy ; Renal Artery Obstruction/mortality ; Renal Artery Obstruction/physiopathology ; Renal Artery Obstruction/therapy ; Stents ; Treatment Outcome
    Chemical Substances Antihypertensive Agents ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Platelet Aggregation Inhibitors
    Language English
    Publishing date 2009-09-24
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa0905368
    Database MEDical Literature Analysis and Retrieval System OnLINE

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