Three Decades of Atherosclerotic Reno-vascular Disease Management - Changing Outcomes in an Observational Study

Abstract

Background/Aims: Optimized medical therapy has improved cardiovascular outcomes in the general population. To investigate whether changes in the management of atherosclerotic renovascular disease (ARVD) have had an impact on clinical outcomes. Methods: Recruitment into this single-center prospective cohort study started in 1986. Data was analyzed retrospectively. Patients were divided into four groups based on relationship of diagnosis year to landmark randomized controlled trials (RCT); group 1 - pre-large RCT data (1986-2000); group 2 - post-early RCT (2001-2004); group 3 - ASTRAL study recruitment era (2004-2009); group 4 - post-ASTRAL (2009-2014). Results: In total, 872 patients were followed for a median 54.9 months (IQR 20.2-96.2). Over successive time-periods, there was an increase in baseline utilization of renin angiotensin blockade (RAB) (group 4: 69% vs. group 1: 31%, p<0.001), statins (74% vs 20%, p<0.001) and beta-blockers (43% vs 30%, p=0.024). Median time to death, end-stage kidney disease and cardiovascular events improved except in group 4, which displayed more baseline cardiovascular comorbidities. The number of investigative angiograms performed decreased from 139 per year between 2006 and 2008 to 74 per year in group 4. Conclusions: Although fewer patients are being investigated for ARVD in our center, these have more cardiovascular comorbidities. Nonetheless, optimized medical therapy may have contributed towards improved proteinuria, renal function and clinical outcomes in patients diagnosed with ARVD.

Association of novel biomarkers with major clinical outcomes in a cohort of patients with atherosclerotic renovascular disease

“…Patients diagnosed with ARVD on radiological imaging and referred to the Salford renal department have been recruited into the Salford Renovascular Study for several decades. 19 Ethical approval for this observational study was granted from the North West – Greater Manchester South Research Ethics Committee (REC 15/NW/0818). The study database is updated on an annual basis from hospital records.…”

“…Data collection has been described elsewhere. 19 In brief, data include baseline demographics, co-morbid conditions (diabetes, macrovascular disease [MVD], congestive heart failure [CHF]), presence of flash pulmonary oedema [FPE]), annualized prescribed medications, blood pressure, routine baseline biochemistry including serum creatinine (υmol/L), parathyroid hormone (PTH) concentrations (pmol/L), baseline proteinuria (g/24 h) and clinical outcome data. The degree of renal artery stenosis (RAS) was obtained from cross-sectional angiography (intra-arterial digital subtraction angiography, computed tomographic or magnetic resonance angiography).…”

Renal Artery Stenosis, Diagnosis and Management: a Literature Review

“…Помимо ВРГ, нарушение почечного кровотока приводит к такому грозному осложнению, как почечная недостаточность [8]. Через активацию ренин-ангиотензин-альдостероновой системы стеноз почечных артерий может стать причиной нестабильной стенокардии и привести к усугублению сердечной недостаточности вплоть до острого отека легких [9,10]. Помимо стенотических поражений, ВРГ наблюдается при травматических повреждениях, диссекции, аневризмах почечных артерий вследствие эмболии или окклюзии.…”

Atherosclerotic Renal Artery Stenosis: Should we Intervene Earlier?

“…Atherosclerotic renal artery stenosis (ARAS) is a leading cause of secondary hypertension and has profound, deleterious effects on the cardiovascular system [ 1 – 3 ] as well as on the kidney [ 4 •, 5 ]. Although there is general agreement that patients with ARAS should be vigorously treated with antihypertensive and lipid-lowering drugs, there is controversy regarding the role of angioplasty with or without stent placement.…”