nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2019-3-326-338nid-299Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОтдалённые клинические результаты эндоваскулярной коррекции стеноза почечной артерииLong-term clinical results of endovascular correction of renal artery stenosisПоповД. Ю.PopovD. Y.noemail@neicon.ruСолодушкинС. И.SolodushkinS. I.noemail@neicon.ruСтолярА. Г.StolyarA. G.ambr375@mail.ruКафедра управления сестринской деятельностью ФГБОУ ВО "Уральский государственный медицинский университет" Минздрава РоссииРоссияDepartment of Nursing Management, Ural State Medical UniversityRussian FederationКафедра вычислительной математики и компьютерных наук ФГАОУ ВО "Уральский федеральный университет имени первого Президента России Б.Н. Ельцина"РоссияDepartment of Computational Mathematics and Computer Science, B.N. Yeltsin Ural Federal UniversityRussian FederationНефрологическое отделение ГБУЗ СО "Свердловская областная клиническая больница № 1"РоссияDepartment of Nephrology, Sverdlovsk Regional Clinical Hospital № 1Russian Federation201907082024213326338Copyright © Попов Д.Ю., Солодушкин С.И., Столяр А.Г., 20242024Попов Д.Ю., Солодушкин С.И., Столяр А.Г.Popov D.Y., Solodushkin S.I., Stolyar A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/299

Актуальность: стеноз почечной артерии является серьёзной патологией, приводящей к потере функции почек и прогрессированию артериальной гипертензии (АГ). Цель работы: оценить отдалённые клинические результаты эндоваскулярной коррекции стеноза почечной артерии (ЭКСПА). Материалы и методы: отдалённые результаты ЭКСПА проанализированы у 167 пациентов, которым было выполнено 205 вмешательств. Все пациенты имели артериальную гипертензию, которая была констатирована в соответствии с рекомендациями ВОЗ (1999), и хроническую болезнь почек (ХБП), определённую по скорости клубочковой фильтрации (СКФ) с использованием формулы CKD-EPI. Результаты ЭКСПА оценивались в срок 1 и 3 года после вмешательства. Анализировались выживаемость пациентов, выживаемость почечной артерии, под которой понимали проходимость почечной артерии до окклюзии, либо до развития гемодинамически значимого рестеноза, функциональное состояние почек (по стадии ХБП, уровню креатинина сыворотки и СКФ), а также среднее артериальное давление (АД) и степень контроля АД до и после ЭКСПА. Результаты: выживаемость пациентов после ЭКСПА составила: 1-летняя - 99%, 3-летняя и 5-летняя - 93%, а выживаемость почечной артерии: 92%, 90% и 84% соответственно. Уровень креатинина через 1 и 3 года после ЭКСПА значимо снизился (p<0,001, критерий Стьюдента), как и стадия ХБП через 1 и 3 года после ЭКСПА (p=0,001, критерий Уилкоксона). СКФ через 1 и 3 года после ЭКСПА значимо увеличилась (p<0,001, p<0,01, критерий Стьюдента). Среднее АД и степень контроля АД через 1 и 3 года после ЭКСПА также значимо снизились (p<0,001, критерий Уилкоксона). Выводы: ЭКСПА высоко результативна в отношении восстановления проходимости почечных артерий, что позволяет сохранить и улучшить функцию почек, а также более эффективно контролировать артериальную гипертензию.

Relevance: renal artery stenosis is a serious pathology leading to the loss of renal function and progression of hypertension. Objective: to evaluate the long-term clinical results of endovascular correction of renal artery stenosis (ECRAS). Materials and methods: we analyzed the long-term results of endovascular correction of renal artery stenosis (ECRAS) in 167 patients who received 205 interventions. All patients had hypertension established in accordance with WHO recommendations (1999), and chronic kidney disease (CKD) determined by glomerular filtration rate (GFR) using CKD-EPI formula. We evaluated EСRAS results at 1 and 3 years after the intervention. We have analyzed patient survival, renal artery survival (estimated by the renal artery patency before occlusion or before the development of hemodynamically significant restenosis), the functional state of kidneys (according to CKD-stage, serum creatinine level and GFR), as well as the average blood pressure (BP) and the degree of BP control before and after EСRAS. Results: survival rate of patients after ECRAS was: 1 year 99% patients, 3 years and 5 years 93% patients, and survival of renal artery: 92%, 90% and 84% respectively. Creatinine level at 1 and 3 years after EСRAS significantly decreased (p<0,001, Student's test), as did the CKD-stage at 1 and 3 years after EСRAS (p=0,001, Wilcoxon test). GFR at 1 and 3 years after EСRAS significantly increased (p<0,001, p<0,01, Student's test). The average BP and the degree of BP control at 1 and 3 years after EСSRAS also significantly decreased (p<0,001, Wilcoxon test). Conclusions: EСRAS is highly effective in restoring renal artery patency. It allows one to preserve and improve renal function, as well as more effectively control hypertension.

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The authors declare that there are no conflicts of interest present.