Balloon pulmonary angioplasty (BPA) used as a staged procedure in individuals with chronic thromboembolic pulmonary hypertension (CTEPH) is safe for renal function. Moreover, it was associated with a slight improvement in renal function in individuals with chronic kidney disease (CKD) stage ≥2, according to a study recently published in the Scandinavian Journal of Clinical and Laboratory Investigation.

In this study, investigators aimed to characterize the incidence of acute kidney injury during BPA and its effect on CKD during follow-up. The investigators included individuals with CTEPH who underwent BPA treatment and completed a 6-month follow-up between March 2014 and 2017. There were 51 individuals included (28 women; mean age, 63.1±11.5 years).

BPA was performed as a staged procedure, the indication for BPA was technically inoperable status with peripheral target lesions in 47 (92.2%) individuals and a status after pulmonary endarterectomy with recurrent pulmonary hypertension in 4 (7.8%) individuals. Evaluation of biomarkers was performed at baseline, prior to and after each BPA, and at 6-month follow-up. Individuals underwent an average of 5±2 BPA sessions, in each session, individuals received 133±48 mL (range, 21-300 mL) mL of contrast agent and 691±241 mL (range, 240-1410 mL) during the whole sequence.

Acute kidney injury occurred after 6 (2.3%) procedures, levels of creatinine (80.1 µmol/L, interquartile range [IQR] 67.8-96.8 µmol/L] vs 77.4 µmol/L [IQR 66.9-91.5 µmol/L]; P =.02) and urea (13.7 µmol/L [IQR 10.7-16.6 µmol/L] vs 12.5 µmol/L [IQR 10.0-15.5 µmol/L]; P =.02) decreased from baseline to the 6-month follow-up. In contrast, the estimated glomerular filtration rate (79.3 mL/min/m² [IQR 59.0-93.9 mL/min/m²] vs 79.6 mL/min/m² [IQR 67.1-95.0 mL/min/m²]; P =.11) did not change from baseline to the 6-month follow-up.

CKD stages at baseline were: G1:15; G2:23; G3a:10; G3b:2; G4:1; G5:0. In individuals with CKD-stage ≥2, the analysis showed increased estimated glomerular filtration rate and decreased levels of creatinine and urea from baseline to 6-month follow-up. The baseline-CKD-stage improved in 14 (41.2%) individuals.

Limitations of this study included a small number of patients, especially with severe renal dysfunction at baseline.

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The researchers concluded that regarding the periprocedural effects on renal function in patients with CTEPH, BPA therapy is a safe approach. Furthermore, BPA therapy improves pulmonary and systemic hemodynamics, which have positive effects on renal function. Finally, the repetitive administration of contrast agent seems not to affect the renal function.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to original reference for a full list of authors’ disclosures.

Reference

Kriechbaum SD, Wiedenroth CB, Hesse ML, et al. Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension [published online April 15, 2019]. Scand J Clin Lab Invest. doi:10.1080/00365513.2019.1601765