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Progression of renal artery stenosis in patients undergoing cardiac catheterization
J J Crowley1, R M Santos, R H Peter
1Duke University Medical Center, Durham, NC 27710, USA. crowl1006@clio.mc.duke.edu
Insights
Renal artery disease is common in patients undergoing cardiac catheterization and often progresses. Significant stenosis can develop quickly, impacting kidney function, highlighting the need for monitoring.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Radiology
Background:
- Renal artery stenosis (RAS) is a treatable condition, but its natural history is poorly understood.
- Lack of data on RAS progression hinders appropriate treatment selection.
- This study investigates the prevalence, progression, and renal function impact of angiographically detected RAS in patients undergoing cardiac catheterization.
Purpose of the Study:
- To determine the prevalence of renal artery stenosis in patients undergoing cardiac catheterization.
- To identify risk factors for the progression of renal artery stenosis.
- To assess the effect of renal artery stenosis on renal function over time.
Main Methods:
- A retrospective analysis of 14,152 patients who underwent abdominal aortography during cardiac catheterization between 1989 and 1996.
- Quantification of renal artery stenosis severity.
- Multivariate logistic regression to identify predictors of stenosis and progression.
- Assessment of renal function (serum creatinine) at baseline and follow-up.
Main Results:
- 88.7% had normal renal arteries, 5.1% had insignificant disease, and 6.3% had significant renal artery stenosis (RAS).
- Independent predictors of significant RAS included elevated creatinine, coronary artery disease (CAD), peripheral vascular disease (PVD), hypertension, cerebrovascular disease, older age, female sex, and family history of CAD.
- Significant disease progression occurred in 11.1% of patients over a mean follow-up of 2.6 years. Predictors of progression included female sex, age, baseline CAD, and time between studies.
- Patients with >=75% stenosis had significantly higher serum creatinine levels at follow-up compared to those with insignificant disease.
Conclusions:
- Renal artery disease is frequently progressive in patients evaluated for coronary artery disease.
- Significant renal artery stenosis can develop rapidly, even after prior normal findings.
- Monitoring renal function and stenosis progression is crucial in this patient population.
Background:
Renal artery stenosis is potentially correctable by either revascularization surgery or percutaneous methods. However, appropriate use of these techniques has been hampered by a lack of data on the natural history of this disease. This study assesses the prevalence, risk factors for progression, and effect on renal function of angiographically demonstrated renal artery disease in patients undergoing cardiac catheterization.
Methods:
The severity of renal artery stenosis was quantified in all patients who underwent abdominal aortography as part of a diagnostic cardiac catheterization study at Duke University Medical Center between January 1989 and February 1996.
Results:
There were 14,152 patients in the study (mean age 61+/-12 years, 62% male). Normal renal arteries were identified in 12,543 (88.7%) patients, insignificant disease (<50% stenosis) in 1 or more vessels in 726 patients (5.1 %), and significant stenosis in 883 patients (6.3%). Significant bilateral renal artery stenosis was present in 178 patients (1.3%). By multivariate logistic regression, elevated serum creatinine level, coronary artery disease, peripheral vascular disease, hypertension, cerebrovascular disease, older age, female sex, and family history of coronary artery disease were identified as independent predictors of significant renal arterial disease. Disease progression was assessed in 1189 patients. Mean time between cardiac catheterizations was 2.6+/-1.6 years. Significant disease progression occurred in 133 patients (11.1 %). Independent predictors of disease progression were female sex, age, coronary artery disease at baseline, and time between baseline and follow-up. At follow-up, serum creatinine level was significantly higher in patients who demonstrated > or =75% stenosis in 1 or more vessels (mean creatinine level 141+114 micromol/L compared with those with insignificant disease (mean creatinine level 97+/-44 micromol/L (P= .01).
Conclusions:
Renal artery disease is frequently progressive in patients who undergo cardiac catheterization for investigation of coronary artery disease. Significant stenotic disease may develop over a short period despite evidence of normal renal arteries at prior catheterization.
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