Incidental Renal Artery Stenosis Is an Independent Predictor of Mortality in Patients with Peripheral Vascular Disease

Abstract

In patients with peripheral vascular disease (PVD), mortality is high and renal artery stenosis (RAS) is a frequent incidental finding. RAS carries a high risk for mortality, but whether incidentally discovered RAS is a risk factor for mortality is unknown. The prognostic impact of incidental RAS for mortality was studied in 550 consecutive patients who underwent intra-arterial digital subtraction angiography for PVD in a single center between 1997 and 2000. In 491 patients (336 men, 155 women; mean follow-up 3.8 ؎ 1.9 yr), the renal arteries were visualized and follow-up data were available. RAS (diameter reduction >50%) was present in 26% of the patients. Mortality in the RAS group was 59 versus 28% in the non-RAS group (odds ratio 3.8; 95% confidence interval 2.5 to 5.7; P < 0.0001). Diabetes, previous myocardial infarction, history of PVD, stroke, and hypertension were more frequent in the RAS group; age was higher and GFR was lower in the RAS group. Therefore, RAS was associated with elevated mortality and increased prevalence of cardiovascular risk factors. Cox regression analysis showed that RAS was an independent predictor for mortality (P ‫؍‬ 0.005), along with age, diabetes, smoking, previous myocardial infarction, history of PVD, and stroke. In patients who were evaluated for PVD by digital subtraction angiography, mortality was high. Incidental RAS was a frequent finding and an independent predictor for mortality. Whether RAS is a marker for or, alternatively, a mediator of the poor prognosis and whether prognosis can be improved by specific intervention should be the subject of future prospective studies.

Prevalence and risk factors for renal artery stenosis and chronic kidney disease in Japanese patients with peripheral arterial disease

“…However, many cases of RAS do not present with specific symptoms of ischemia, unlike CHD or PAD, and incidental RAS has been reported to be an independent predictor of mortality in patients with PAD. 19 Therefore, screening for RAS is very important for management of patients with PAD. Figure 2 Relationship between renal artery stenosis and risk factors in multiple logistic analysis.…”

Role of Renin-Angiotensin System Blockade in Atherosclerotic Renal Artery Stenosis and Renovascular Hypertension

“…1 The presence of this disease decreases long-term survival by 2-to 4-fold. [1][2][3] An impaired prognosis is also evident in healthy patients with incidentally discovered ARAS. In a cohort of unselected community-dwelling Americans older than 65 years of age, baseline ARAS increased the risk of events by Ϸ3-fold (hazard ratio [HR]: 2.92; 95% CI: 1.53 to 5.57).…”

Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography

“…2,[8][9][10][11][12][13][14][15][16][17][18] A positive association between the presence and severity of RAS and CAD has been described, [11][12][13]16,18,19 and the presence of RAS has been associated with poor cardiovascular outcome. 9,[20][21][22] There is growing evidence that a high percentage of significant atherosclerotic RAS is clinically indolent. [13][14][15][16] In recent years, efforts have been made to determine the prevalence of RAS and its predictors among patients with peripheral and coronary artery disease.…”

“…[13][14][15][16] In recent years, efforts have been made to determine the prevalence of RAS and its predictors among patients with peripheral and coronary artery disease. 20,[23][24][25] Attention has also been paid to the role of ethnicity in the prevalence of RAS. [26][27][28] This study aims to assess the prevalence of RAS in patients with hypertension and suspected CAD who are candidates for coronary angiography.…”