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Philip A Kalra Lead Nephrologist for ASTRAL, Hope Hospital, Salford, UK, On behalf of the ASTRAL TMC and collaborators PowerPoint PPT Presentation


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UK MULTI-CENTRE TRIAL IN ATHEROSCLEROTIC RENOVASCULAR DISEASE ASTRAL A ngioplasty and ST ent for R enal A rtery L esions. Philip A Kalra Lead Nephrologist for ASTRAL, Hope Hospital, Salford, UK, On behalf of the ASTRAL TMC and collaborators. ASTRAL Trial Schema.

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Philip A Kalra Lead Nephrologist for ASTRAL, Hope Hospital, Salford, UK, On behalf of the ASTRAL TMC and collaborators

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  • UK MULTI-CENTRE TRIAL IN ATHEROSCLEROTIC RENOVASCULAR DISEASE

  • ASTRAL

  • Angioplasty and STent for Renal Artery Lesions

Philip A Kalra

Lead Nephrologist for ASTRAL, Hope Hospital, Salford, UK,

On behalf of the ASTRAL TMC and collaborators


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ASTRAL Trial Schema

No revascularisationMedical Treatment only

Revascularisation

with angioplasty and/or stent

(and medical treatment)

Diagnosis of ARVD (Unilateral or Bilateral)Revascularisation not contraindicated

Uncertain whether to revasculariseRandomisation


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PATIENT CHARACTERISTICS BY RANDOMISED TREATMENT


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LABORATORY DATA BY RANDOMISED TREATMENT


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LABORATORY DATA BY RANDOMISED TREATMENT


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ANGIOGRAPHIC DATA BY RANDOMISED TREATMENT


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CONCOMITANT MEDICINE BY RANDOMISED TREATMENT


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CONCOMITANT MEDICINE BY RANDOMISED TREATMENT


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SAFETY – IMMEDIATE POST-OP COMPLICATIONS

  • 24 patients experienced an immediate post-op complication

    • Revascularisation = 23 / 308 (7%)

    • Medical = 1 / 18 (6%)

  • Most patients (88%) had one complication


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PLOT OF SCr OVER TIME


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MEAN CHANGE IN SCr BETWEEN BASELINE AND 1 YEAR

Negative change = Improvement in SCr (i.e. reduction in SCr)


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MEAN CHANGE IN SCr


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MEAN CHANGE IN SYSTOLIC BP


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PLOT OF DIASTOLIC BP OVER TIME


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TIME TO FIRST OF MI, STROKE, VASCULAR DEATH OR HOSPITALISATION FOR ANGINA, FLUID OVERLOAD OR CARDIAC FAILURE

HR=0.90, 95% CI=0.66 to 1.15


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MORTALITY

HR=0.92, 95% CI=0.68 to 1.26


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PRE-SPECIFIED SUBGROUP ANALYSES


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SUMMARY

  • Currently no evidence of a benefit for revascularisation on renal function in the ARVD patients entered into ASTRAL – those in whom clinicians ‘uncertain’ of whether to revascularise

  • Also no evidence of differences between the arms for any of the secondary endpoints (i.e. blood pressure, major events)

  • No evidence of differences in treatment effect across the various subgroups

  • Longer follow-up is needed

  • Plan to update meta-analysis published in NDT in 2003 to include ASTRAL and other trials


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