Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis.

Department of Renal Medicine, Hope Hospital, Salford, United Kingdom.
Kidney International (Impact Factor: 8.52). 07/2005; 68(1):293-301. DOI: 10.1111/j.1523-1755.2005.00406.x
Source: PubMed

ABSTRACT Although atherosclerotic renovascular disease is increasingly recognized in chronic kidney disease, few national level studies have examined its clinical epidemiology.
Claims data from a 5% random sample of the United States Medicare population were used to select patients without atherosclerotic renovascular disease in the 2 years preceding December 31, 1999 (N= 1,085,250), followed until December 31, 2001.
The incidence of atherosclerotic renovascular disease was 3.7 per 1000 patient-years. Major antecedent associations [P < 0.05, with adjusted hazards ratios (HR) > 1.5] included chronic kidney disease (adjusted HR 2.54), hypertension (2.42), peripheral vascular disease (2.00), and atherosclerotic heart disease (1.70). Adverse event rates after incident atherosclerotic renovascular disease greatly exceeded those in the general population (P < 0.0001): atherosclerotic heart disease, 303.9 per 1000 patient-years (vs. 73.5 in the general population); peripheral vascular disease, 258.6 (vs. 52.2); congestive heart failure, 194.5 (vs. 56.3); cerebrovascular accident or transient ischemic attack, 175.5 (vs. 52.9); death, 166.3 (vs. 63.3); and renal replacement therapy, 28.8 (vs. 1.3). Among atherosclerotic renovascular disease patients, 16.2% underwent a renal revascularization procedure, percutaneously in 96%. Revascularization was not associated with renal replacement therapy, congestive heart failure, or death but was associated with atherosclerotic heart disease (adjusted HR 1.42) (P= 0.004) and peripheral vascular disease (adjusted HR 1.38) (P= 0.002).
Atherosclerotic renovascular disease is strongly associated with cardiovascular disease, both past and future. Absolute cardiovascular risk exceeds that of renal replacement therapy. Renal revascularization is used selectively and shows inconsistent associations with cardiovascular outcomes, renal replacement therapy, and death.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To evaluate the 9‐month safety and effectiveness outcomes of the Formula™ balloon‐expandable renal stent (Cook Medical, Bloomington, IN) for the treatment of atherosclerotic renal artery stenosis (RAS) following suboptimal angioplasty. Background Atherosclerotic RAS can cause hypertension and ischemic nephropathy. When clinically indicated, an interventional approach with renal angioplasty and stent implantation is the preferred method for revascularization of atherosclerotic renal artery stenoses. Methods The REFORM study is a prospective, multicenter, single‐arm study of stent implantation following suboptimal PTRA using the Formula stent. One hundred patients with atherosclerotic ostial renal artery lesions =18 mm in length with a >50% residual stenosis following PTA were enrolled. The primary endpoint was 9‐month primary patency. ResultsThe 9‐month primary patency rate was 91.7%. The 9‐month major adverse event rate was 2.2%. Mean systolic blood pressure was significantly decreased at follow‐up (from 150 ± 21 mm Hg at baseline to 141 ± 21 mm Hg at 9 months; P = 0.003). Mean serum creatinine (SCr) level and mean estimated glomerular filtration rate (eGFR) were not significantly different at 9 months. A clinically meaningful improvement in renal function (i.e., =25% increase in eGFR or =0.5 mg/dl decrease in SCr) was observed in 9% of patients at 1 month and 12% of patients at 9 months. A clinically meaningful decline in renal function (i.e., =25% decrease in eGFR or =0.5 mg/dl increase in SCr) was observed in only 3% of patients at 1 month and 7% of patients at 9 months. Conclusions The Formula stent was safe and effective in treating atherosclerotic RAS following suboptimal angioplasty. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 08/2013; 82(2). · 2.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atherosclerotic renovascular disease (ARVD) is associated with high rates of coronary events and predicts mortality among patients with coronary artery disease (CAD). However, the impact of coronary atherosclerosis on renal outcomes after revascularization of ARVD is unclear. We hypothesized that CAD negatively impacts renal functional outcomes among patients with ARVD undergoing renal artery revascularization. Patients with ARVD who underwent echocardiography at Mayo Clinic, Rochester, Minnesota, USA between 2004 and 2012 were identified retrospectively and included if they had ejection fraction more than 50%. Renal and overall outcomes were compared among atherosclerotic renovascular disease patients with coronary artery disease (ARVD-C, n = 75) and without coronary artery disease (ARVD, n = 56) , within 1 year from initial revascularization and included blood pressure control, renal function, and incident cardiovascular/cerebrovascular events. Degree of renal artery stenosis was similar in both groups. ARVD-C had higher prevalence of diabetes, peripheral artery disease (PAD), and cerebrovascular disease, and lower baseline renal function. Risk of developing end-stage renal disease was higher in ARVD-C (11 vs. 2%, P = 0.05). Despite better control of blood pressure and cholesterol levels, renal function postrevascularization worsened in 15% of ARVD-C compared with 2% of ARVD (P = 0.01). Differences in clinical outcomes remained statistically significant after adjustment for covariables, including sex, baseline blood pressure, renal function, underlying diabetes, cholesterol levels, and medications. Similar differences in clinical outcomes were also associated with PAD and cerebrovascular disease. CAD in patients with ARVD is a predictor of worse outcomes after renal revascularization, likely reflecting diffuse atherosclerotic disease. Further studies are needed to develop strategies to manage patients with vascular comorbidities and improve their outcomes.
    Journal of Hypertension 03/2014; · 4.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The association between herpes zoster (HZ) infection and subsequent risk of end stage renal disease (ESRD) in chronic kidney disease (CKD) patients is unknown. We aim to conduct a population-based cohort study to investigate the risks of developing ESRD after a HZ attack in CKD patients. From the Taiwan National Health Insurance Research Database, we identified 1,144 CKD patients who had HZ over the period 1997-2008 as HZ cohort. We selected 3,855 age- and sex-matched CKD patients without HZ as comparison cohort. All subjects were followed until the end of 2008 or censored. Cox-proportional hazard regression model was used to estimate the effects of HZ on ESRD risks. A total of 396 patients developed ESRD during the follow-up period, of which 108 subjects were from the HZ cohort and 288 from the comparison cohort. The log-rank test demonstrated that the HZ cohort had significantly higher risk of developing ESRD than the comparison cohort (P = 0.0071). The adjusted hazard ratio of subsequent ESRD in the HZ cohort was 1.36 (95 % CI 1.09-1.70) and the hazard ratio increased to 8.71 (95 % CI 5.23-14.5) if the HZ cohort was with concomitant diabetes and hypertension. CKD patients with HZ are at an increased risk of subsequent ESRD. CKD patients with HZ, diabetes, and hypertension have extremely high risk of developing ESRD.
    European Journal of Clinical Microbiology 05/2014; 33(10). · 2.54 Impact Factor

Full-text (2 Sources)

Available from
May 15, 2014