Philip A Kalra

1
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
2
ASTRAL Trial Schema
Diagnosis of ARVD (Unilateral or
Bilateral)Revascularisation not contraindicated
Uncertain whether to revasculariseRandomisation
3
PATIENT CHARACTERISTICS BY RANDOMISED TREATMENT
4
LABORATORY DATA BY RANDOMISED TREATMENT
5
LABORATORY DATA BY RANDOMISED TREATMENT
6
ANGIOGRAPHIC DATA BY RANDOMISED TREATMENT
7
CONCOMITANT MEDICINE BY RANDOMISED TREATMENT
8
CONCOMITANT MEDICINE BY RANDOMISED TREATMENT
9
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

10
PLOT OF SCr OVER TIME
11
MEAN CHANGE IN SCr BETWEEN BASELINE AND 1 YEAR
Negative change Improvement in SCr (i.e.
reduction in SCr)
12
MEAN CHANGE IN SCr
13
MEAN CHANGE IN SYSTOLIC BP
14
PLOT OF DIASTOLIC BP OVER TIME
15
TIME TO FIRST OF MI, STROKE, VASCULAR DEATH OR
HOSPITALISATION FOR ANGINA, FLUID OVERLOAD OR
CARDIAC FAILURE
HR0.90, 95 CI0.66 to 1.15
16
MORTALITY
HR0.92, 95 CI0.68 to 1.26
17
PRE-SPECIFIED SUBGROUP ANALYSES
18
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