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Renal artery stenosis reversal in a hypertensive individual, using a combination of EDTA chelation and multiple vitamin and trace mineral therapy.

Abstract: A 70-year-old, white male patient presented with a history of severe hypertension and left renal artery stenosis. Doppler duplex scanning revealed a peak systolic velocity blood flow in excess of 200 cm/sec in the renal artery. The renal artery to aorta flow velocity ratio was greater than 3:5. The patient was treated with a combination of intravenous chelation therapy using a series of 3 gram infusions of ethylene diamine tetracetic acid (EDTA), together with orally administered multivitamin and trace minerals. After treatment, the patient's blood pressure was reduced, requiring less medication. Blood flow in the left renal artery and the renal artery/aorta flow ratio were within normal limits.

Introduction

This case report continues a series of papers analyzing effects of intravenous EDTA infusions. We have previously published data on the improvement in circulation in the carotid arteries, (1,2,3) the lower extremities, (4) and in functional cardiac improvement as measured through sub-maximal treadmill testing (5) and coronary angiography. (6) We have also reported an individual with macular degeneration whose retinal artery prefusion was improved as measured by retinal autoperimetry studies. (7)

In treating the patients that were subjected to these various studies, it was noted that if hypertension were present with vascular disease, there was improvement in blood pressure after EDTA chelation. There was improvement in systolic blood pressure in all stages of sub-maximal treadmill testing in patients undergoing the treatment. (8)

Case Report

CM, a 70-year-old, white male patient, presented to our clinic with a longstanding history of hypertension due to left renal artery stenosis. He had previously been diagnosed with the condition by a vascular surgeon in 1997, using real-time ultrasound, color, duplex Doppler. He had been told that the only effective therapy was surgical, either angioplasty or bypass. When first seen at this clinic in June of 1997, he had been subjected to a series of diagnostic tests on his vascular system that showed moderate aorto-iliac occlusive disease. A stress electrocardiogram was performed but, while negative for ischemia, was limited in value due to the development of claudication.

The patient then received a course of 70 intravenous infusions, each containing 3 grams of EDTA. He also received supplements of multivitamins and trace minerals according to the protocol of the American College for Advancement in Medicine (ACAM). (9) Blood pressure medication included verapamil extended release 240 mg in the morning and doxazosin mesylate 2 mg at bedtime. They were continued throughout the study at the same dose, but no additional treatment was given other than the chelation and nutritional supplements. The patient was re-tested with a second renal ultrasound study after receiving 70 EDTA chelation treatments.

Results

Table 1 shows the flow velocities in the renal arteries as determined by diagnostic ultrasound performed in the radiology department in Heartland East Hospital, St. Joseph, Mo. The equipment used for the duplex scan was an Acuson 128XP diagnostic ultrasound. The velocity of flow in a healthy renal artery is in the range of 100 cm/second (10) and increases proportionately with the degree of stenotic narrowing of the lumen. This flow velocity is also dependent upon concomitant flow in the aorta as it varies. It is therefore helpful to express the flow of blood in the renal artery as a ratio to that in the aorta. Thus, peak flow in the renal artery is reported together with the renal artery/aorta flow ratio. This allows the flow measurement to be standardized.

When this patient was first examined, the peak velocity in his left renal artery was 206 cm/sec. After the chelation treatment, the test was repeated and the peak flow was recorded as 113 cm/sec. The renal artery/aorta blood flow ratio initially in this patient was 3.75 and, when the test was repeated, it was recorded as 1.69. The normal for this ratio, as published by Kohler, et al, (11) is less than 3.5. In this publication, a table illustrates the distribution of non-stenotic and stenotic patients with reference to the renal artery/aorta ratio.

By using angiography and comparing it with Doppler readings, 60% occlusion of the renal artery, considered to be the threshold where a lesion becomes hemodynamically significant, is equivalent to a renal artery/aorta ratio of 3.5. (11) Using the table published by Kohler, et al, it is possible to conclude that our patient had an occlusion in the left renal artery in the 60-70% range. By the same token, it is possible to conclude that the occlusion was reduced to 20% or less after chelation and nutritional supplementation. This obviously represents a significant hemodynamic improvement in renal artery blood flow.

Since the presenting symptom of this patient was hypertension, the improvement in renal artery stenosis should hopefully lead to clinical change in blood pressure. The patient's blood pressure was measured each day prior to his intravenous infusion of EDTA. The measurements showed a decrease in the systolic pressures, whereas the diastolic readings remained relatively constant in the range below 90 mm Hg.

The true time interval between infusions varied, but on the average the patient received infusions three times weekly for the first 30, twice weekly for the next 10 infusions, weekly for the subsequent 10, and every other week for the remainder.

Discussion

These data indicate that EDTA chelation, in combination with nutrient supplements, had a dramatic effect upon the renal artery stenosis and the hypertension that was secondary to it. From past clinical experience, the use of low fat and low sodium diet and nutritional supplementation may improve hypertension, but they have never been demonstrated to have a therapeutic effect on renal artery stenosis. Angioplasty and renovasular surgical treatment are the current method of choice, but risks include embolization, restenosis, anesthetic reactions and even death.

Renal artery stenosis is a definable cause of hypertension. A fixed obstruction in a renal artery causes an elevation of serum rennin, angiotensin and, ultimately aldosterone. Intrinsic lesions can be either atherosclerotic (67%) or fibromuscular (33%) in origin. Patients with atherosclerotic lesions tend to be older, have higher systolic blood pressures, and are more likely to develop end-organ damage than those with the fibromuscular type of lesions that are found usually in younger people, more commonly females.

Hypertension from this cause is generally only amenable to surgical intervention. Angioplasty in the atherosclerotic type has a success rate in the 60-70% range and is invasive. If renovascular surgery is required, the cure rate is in the 40-50% range. If a patient has had hypertension for more than 5 years, only 25% have a favorable response to surgery. (12) Although only a single case, the response from EDTA chelation in this patient strongly suggests that it should be first choice before risking surgical intervention, particularly with the indifferent results. Neither is it possible to separate the effectiveness of nutritional therapy from that of EDTA chelation. The fact remains, however, that highly significant clinical improvement occurred in a condition that is traditionally considered to be only amenable to surgical intervention. It is also highly unlikely that nutritional supplementation would do this on its own.

Our experience (2-6) is that EDTA chelation has a marked benefical effect in all areas of the circulatory system and that the best approach to a systemic problem is a systemic solution. Even if the renal artery stenosis is only the "tip of the iceberg," there may be a significant presence of other vascular lesions that have not yet resulted in expression.

There are numerous causes of hypertension besides that related to kidney dysfunction. (13) Heavy metals are also known to be powerful pressor substances. Patients with both hypertension and reduced renal function (serum creatinine > 1.5 mg/dl) had significantly larger amounts of mobilizable lead than did patients without renal impairment, suggesting that lead may play a role in essential hypertension. (14)

As EDTA chelation is the treatment of choice in lead poisoning, it may be the treatment of choice if lead can be shown to be an etiologic factor. (14) Cadmium, another toxic pressor, is thought to displace zinc in tissues, especially the kidney. This is most likely to be responsible for the effect of cadmium in blood pressure. (15) Since cadmium had been used in tobacco products, it may be the mechanism that affects human health and cardiovascular status. (16) Mercury binds strongly to sulfhydryl groups in the renal parenchyma and can cause toxicity and result in hypertension. (17) A screening test by hair analysis in this patient did not reveal any increases in these heavy metals, and there was no indication to pursue this further as a possible etiology.

The improvement seen in renal artery flow in this patient might be confusing to some, since the earlier studies suggested that EDTA was nephrotoxic. Cranton (18) reported on this subject in a comprehensive review. He noted that the intial studies used much higher infusion rates (half an hour versus three hours). This resulted in an assault on the renal tubular system that was, on occasion, irreversible. McDonagh and associates (19) followed that up with a 383-patient study using current protocol. They found that this treatment did not result in renal damage and kidney function actually improved about 15% as measured by pre- and post-treatment serum creatinine. These effects were later confirmed by a similar study showing a reduction in blood urea nitrogen in patients treated with EDTA chelation therapy. (20) As the kidney is perhaps the most important tissue for regulating blood pressure, we originally assumed that the beneficial effects in hypertensive patients were related to removal of heavy metals. The fact that there was actual improvement in the renal function was, however, suggestive that the mechanism of blood pressure reduction might actually be in improving renal circulation.

Hypertension, high cholesterol, diabetes mellitus, and obesity are significant risk factors for vascular occlusive disease. Untreated hypertension may result in thrombotic or hemorrhagic cerebrovascular accidents, renal insufficiency, congestive heart failure and coronary heart disease with subsequent myocardial infarction. (21,22)

To our knowledge, this is the first article in which hemodynamically demonstrable improvement in a renal artery lesion has been shown after treating a patient with the combination of EDTA chelation and multivitamin, trace mineral therapy. The patient remains well and his blood pressure is well-maintained, with reduction in the dose of his medication.

Conclusion

Hypertension is one of the leading causes of vascular disease in the elderly in this country. While not associated directly with a high mortality, it is a direct precursor to the first- (heart disease) and third-ranked (stroke) causes of death in the United States. With the escalating, if not astronomical, health care costs of today, it is reassuring that there exists a therapy that has a multifold potential. This technique is a relatively low-cost therapy for this and other degenerative disorders. It may offer a solution not only to the chronic problem of hypertension, but also to the feared lethal conditions to which it can lead.

REFERENCES

1) McDonagh EW, Rudolph CJ, and Cheraskin E. "An oculocere-brovasculometric analysis of the effect of EDTA chelation upon vascular stenosis." J Holist Med, 1982; 4:21-23.

2) Rudolph CJ and McDonagh EW. "Effect of EDTA chelation and supportive multivitamin trace mineral supplementation on carotid circulation: Case report." J Adv Med, 1990; 3:5-11.

3) Rudolph CJ, McDonagh EW, and Barber RK. "A nonsurgical approach to carotid stenosis using EDTA chelation." J Adv Med, 1991; 4:157-166.

4) McDonagh EW, Rudolph CJ, and Cheraskin E. "The effect of EDTA chelation therapy plus multivitamin trace mineral supplementation upon vascular dynamics (ankle/brachial systolic blood pressure)." J Holist Med, 1985; 7:16-22.

5) Cheraskin E, Wussow DG, McDonagh EW, et al. "Effect of EDTA chelation and supportive multivitamin/trace mineral supplementation with and with out physical activity on heart rate." J Int Acad Prev Med, 1984; 8(6):5-9.

6) McDonagh EW and Rudolph CJ. "Non-invasive treatment for sequella of failed coronary blood circulation, 100% occlusion of left anterior descending coronary artery and 30% stenosis of right cornary artery and left ventricular contractility deficit." J Neuro Orthoped Med Surg, 1993; 14:169-173.

7) Rudolph CJ, McDonagh EW, and Samuels R. "Visual field eveidence of macular degeneration reversal using EDTA chelation therapy and combined multivitamin trace mineral therapy." J Adv Med, 1994; 7:231-240.

8) McDonagh EW, Rudolph CJ, Cheraskin E, et al. "The effect of EDTA and supportive multivitamin/trace mineral supplementation with and without physical activity upon systolic blood pressure." J Orthomol Psych, 1984; 13:1-9.

9) Cranton EM. "Protocol of the American College for Advancement in Medicine for the safe and effective administration of EDTA chelation therapy." J Adv Med, 1989; 2:269-306.

10) Avasti PS, Voyles WF, and Green ER. "Non-invasive diagnosis of renal artery stenosis by echo Doppler velocities." Kidney Int, 1984; 25:824-829.

11) Kohler TR, Zierler RE, Martin RL, et al. "Non-invasive diagnosis of renal artery stenosis by ultrasonic duplex scanning." J Vasc Surg, 1986; 4:450-456.

12) Cecil's Textbook of Medicine, 18th edition. Wyngaarden JB and Smith LH, editors. 1988; 280-291.

13) Current Diagnosis. Conn RB, editor. W B Saunders, Philadelphia, 1991; 409-411.

14) Batuman V, Landy E, Maesaka JK, et al. "Contribution of lead to hypertension with renal impairment." NEJM, 1983; 390:17-21.

15) Perry H. "Hypertension and the geochemical environment." Ann NY Acad Sci, 1972; 199:202-206.

16) Cadmium in the Environment. Friberg L, editor. CRC Press, Cleveland, 1971.

17) Pier SM. "The role of heavy metals in human health." Tex Rep Biol Med, 1975; 33:85-106.

18) Cranton EM. "Kidney effects of ethylene diamine tetracetic acid: A literature review." J Holist Med, 1982; 4:152-167.

19) McDonagh EW, Rudolph CJ, and Cheraskin E. "The effect of EDTA chelation therapy plus supportive multivitamin-trace mineral supplementation upon renal function: a study in serum creatinine." J Holist Med, 1982; 4:146-151.

20) McDonagh EW, Rudolph CJ, and Cheraskin E. "The effect of EDTA chelation therapy plus supportive multivitamin-trace mineral supplementation upon renal function: a study in blood urea nitrogen (BUN)." J Holist Med, 1983; 5:163-171.

21) Kannel WB. "Some lessons in cardiovascular epidemiology from Framingham." Ann J Cardiol, 1976; 37:269-282.

22) Kannel WB, Wolf PA, Verter J, et al. "Epidemiologic assessment of the role of blood pressure in stroke: The Framingham study." JAMA, 1970; 214:301-310.

by CJ Rudolph, DO, PhD, FACAM, and EW McDonagh, DO, ACGP, FACAM
Table 1 Flow Velocity in Renal Artery before and after Patient was
Treated

Ratio           Flow Velocity  Renal AorticRatio

Pre-Treatment   206 cm/sec     3.75
Post-Treatment  113 cm/sec     1.69

The patient was treated with 70 infusions of EDTA chelation. The renal
aortic ratio is a measure of the flow velocity in the renal artery
divided by the blood flow in the aorta and indicates stenosis if it is
>3.50.
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Author:Rudolph, C.J.; McDonagh, E.W.
Publication:Original Internist
Article Type:Disease/Disorder overview
Geographic Code:1USA
Date:Mar 22, 2006
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