Kalra, P. A. et al. Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis. Kidney Int. 68, 293-301

Department of Medicine , Tufts Medical Center, Boston, Massachusetts, United States
Kidney International (Impact Factor: 8.56). 07/2005; 68(1):293-301. DOI: 10.1111/j.1523-1755.2005.00406.x
Source: PubMed


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.

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Available from: Areef Ishani, Mar 25, 2014
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    • "Mortality rates are high in ARVD, with patients six times more likely to die of a cardiovascular event than progress to ESKD. The earlier Medicare analysis showed that annual mortality rates in patients with ARVD (16.3%) were almost three times greater than general Medicare patients without the condition.3 Improved understanding of how best to manage these patients has likely contributed to reducing this gap, with an average annual mortality rate of 8% in ARVD patients in the most recently published RCT data.8 "
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    International Journal of Nephrology and Renovascular Disease 02/2014; 7:89-99. DOI:10.2147/IJNRD.S35633
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    • "The ASTRAL study showed that 8% of 403 patients deteriorated to ESRD in a median follow-up of 33.6 months [11]. The annual rate of ESRD in the Medicare study of RVD was 2.9% per year [3]. A hospital RVD cohort in the United Kingdom showed annual rates of deterioration to ESRD of 3.5% in 1995 to 2000, 2.3% in 2000 to 2005, and 0.8% for patients diagnosed since 2005 [4], which is similar to our data shown in Fig. 2. In conclusion, this is the first whole population-based report on the incidence of RVD. "

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