Fifty studies assessed percutaneous transluminal renal angioplasty: 47 studies of adults (1,616 participants, range five to 442) and three paediatric studies (47 patients). Twenty-five studies assessed surgery: 23 studies of adults (1,014 participants, range six to 179) and two paediatric studies (60 patients).
Five studies reported prospective recruitment, 17 reported consecutive recruitment, 21 provided details on study population and 58 reported complete patient follow-up. No other details on study type were reported.
The success rate for percutaneous transluminal renal angioplasty in adults was 88.2% (95% CI 83.5% to 92.2%; 27 studies) with statistical heterogeneity (Ι²=77%).
For percutaneous transluminal renal angioplasty the combined rate in adults was high at 11.8% (95% CI 8.2% to 15.9%; 20 studies) but with statistical heterogeneity (Ι²=55%). Complication rates included 0.9% (death) and 8.3% (kidney complications).
The combined rate in adults who underwent surgery was high at 16.9% (95% CI 10.3% to 24.7%) and most were major complications. There was statistical heterogeneity (Ι²=52%). Sixteen of 18 studies reported no deaths; perioperative risk of death was 1.2% (95% CI 0.5% to 2.1%). Three children experienced complications.
Blood pressure outcomes:
In adults, the hypertension cure rate for percutaneous transluminal renal angioplasty was 45.7% (95% CI 39.8% to 51.7%; 47 studies) but with statistical heterogeneity (Ι²=78%). The combined rate for cure or improvement was 86.4% (95% CI 83.2% to 89.3%) with statistical heterogeneity (Ι²=58%). Cure rates in the three studies in children were high at 100%, 67% and 80%.
In adults who underwent surgery the combined cure rate was 57.5% (95% CI 53.0% to 62.0%; 23 studies) with statistical heterogeneity (Ι²=47%). The combined rate for cure or improvement was 88.3% (95% CI 83.2% to 92.6%) with statistical heterogeneity (Ι²=80%). Sensitivity analyses did not significantly alter the findings. In the two paediatric studies cure rates were 59.2% (16 of 27 children) and 87.9% (29 of 33 children).
Hypertension cure rates using different study definitions were reported in the review.
Results from subgroup analyses and meta-regression were reported in the review. There was no evidence of publication in the funnel plots.