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

Ghaffari, Samad; Sohrabi, Bahram; Siahdasht, Reza Beheshti; Pourafkari, Leili

doi:10.1038/hr.2009.149

Cited by 14 publications

(13 citation statements)

References 43 publications

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“…1,2 Recent studies have shown a high prevalence of RAS in patients with peripheral arterial disease (PAD) or coronary heart disease (CHD). 1,3 However, many cases of RAS do not present with specific symptoms or signs of ischemia, unlike PAD or CHD, and there is little information on the prevalence of RAS in Japanese patients with PAD. PAD is an atherosclerotic disease that has multiple atherosclerosis risk factors and a high incidence of coexisting atherosclerotic vascular disease.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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The prevalence and risk factors for renal artery stenosis (RAS) and chronic kidney disease (CKD) are unclear in Japanese patients with peripheral arterial disease (PAD). To examine these issues, we performed renal angiography in 410 patients with PAD. Renal function and damage were assessed using the estimated glomerular filtration rate (eGFR) and urinary level of microalbumin (MA). Multiple logistic and multiple regression analyses were used to examine the relationships of potential risk factors with RAS and CKD. In all, 94 subjects (22.9%) had RAS 450% and 45 subjects (11.0%) had RAS 475%. The incidences of an abnormal level of MA and renal insufficiency (eGFR o60 ml min -1 per 1.73 m 2 ) were 37.0 and 60.7%, respectively. RAS X50% was associated with critical limb ischemia (CLI; hazard ratio (HR) 2.519; 95% confidence interval (CI) 1.203-5.276, P¼0.014), coronary heart disease (CHD; HR 2.143; 95% CI 1.129-4.069; P¼0.020) and hypertension (HR 1.907; 95% CI 1.009-3.628; P¼0.045). RAS X75% had a relationship with hypertension (HR 3.093; 95% CI 1.002-9.548; P¼0.048). eGFR was negatively correlated with age, uric acid and CHD (P¼0.013), and MA had a significant positive correlation with low-density lipoprotein cholesterol, CLI, age, CHD and diabetes (Po0.001). These results show that the prevalences of RAS and CKD are very high in Japanese patients with PAD; that CLI and CHD are major risk factors for RAS; and that hyperuricemia, hypercholesterolemia and diabetes are risk factors for CKD in PAD. We also found that MA is a simple and noninvasive marker of renal dysfunction and general vascular damage.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…In this category of patients the prevalence of APE in bilateral/SFK was approximately equal to that in unilateral RAS and higher than in the control group, but did not reach statistical significance probably due to the small number of cases. One study with control group was realized in 732 hypertensive patients undergoing coronary angiography which analysed the prevalence and predictors of RAS in this category of patients [48]. They found a medical history of pulmonary edema in 6.9% (6/87) of patients with RAS ≥ 50% and 1.4% (9/645) of those without or with RAS<50%.…”

Section: Discussionmentioning

confidence: 99%

“…Atherosclerotic RAS is located mostly in the proximal portion of the artery, affects older people [8][9][10][11], and is very often associated with other atherosclerotic determinations, especially with aortic, peripheral and coronary artery disease [12][13][14][15][16][17][18][19][20][21]. The decrease of systemic blood pressure or renal function improvement after revascularization through percutaneous transluminal renal artery angioplasty is still controversial [22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Renal Artery Stenosis and Acute Pulmonary Edema-A Possible Correlation beyond Pickering Syndrome

Ro¹,

Ad²,

Vinereanu³

2015

J Clin Exp Cardiolog

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Objectives: The association of renal artery stenosis (RAS) with acute pulmonary edema (APE) is considered specific for bilateral or solitary functioning kidney (SFK) RAS. We aimed to check if APE is also associated with unilateral RAS when both kidneys are functional. Method:A series of 189 patients with uncontrolled hypertension were investigated for RAS suspicion by duplex ultrasonography. Clinical criteria considered in current guidelines as predictors of RAS were recorded and analysed.Results: Potentially hemodynamically significant RAS (≥ 50%) was identified in 29% of cases (55/189): unilateral in 35 cases (group A), bilateral or on SFK in 20 cases (group B). The remaining 134 were designated controls (group C). Age, blood pressure and gender did not differ between groups. The presence of acute pulmonary edema was higher in both groups of patients with RAS (23%-group A (p<0.01) and 20%-group B vs 8% in control group). The prevalence of azotemia and of azotemia under angiotensin converting enzyme inhibitors or angiotensin II receptor blockers were significantly higher in group B (p<0.01 vs. group A, p<0.00001 vs. control). Linear discriminant analysis based on: age, gender, abdominal bruit, vascular disease, renal dysfunction and azotemia under angiotensin converting inhibitors or angiotensin II receptor blockers, had an accuracy of 0.70 for unilateral RAS, 0.85 for bilateral/SFK RAS, and 0.77 for both. This accuracy was not improved when adding APE as a predictive variable. Conclusions:In a series of hypertensive patients evaluated for renovascular disease the prevalence of APE is higher in patients with RAS. We have found a significant association of RAS with APE for unilateral RAS. This association, little emphasized until present, might contribute to the clarification of the flash pulmonary edema mechanisms beyond those related to bilateral/SFK RAS.

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“…4 The reported prevalence of significant RAS (50%) among patients undergoing coronary angiography ranges from 6.2% to as high as 28%. 5 A positive association between the presence and severity of RAS and CAD has been described and the presence of RAS has been associated with poor cardiovascular outcome. In recent years, efforts have been made worldwide to determine the prevalence of RAS and its predictors among patients with peripheral and coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Predictors of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease

Sai

Kumar

Srinivas

et al. 2015

Journal of Indian College of Cardiology

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Available online xxx Keywords:Renal artery stenosis Coronary artery disease Cardiac catheterization a b s t r a c t Aim: This study determined the prevalence of Renal Artery Stenosis (RAS) and established its predictors in patients undergoing cardiac catheterization for suspected Coronary Artery Disease (CAD). Methods: 1266 patients underwent coronary angiogram for suspected CAD. Following coronary angiogram, bilateral selective renal angiogram was performed. Study population was split into cohorts with and without RAS. A binary logistic regression model was used to identify univariate predictors of RAS. Significant univariate predictors were used to build a multivariate logistic regression model. Comparative accuracy of various models in predicting RAS was estimated by computing areas under the Receiver Operating Characteristic (ROC) curve.Results: Prevalence of significant RAS in study population was 6.0%. In univariate analysis, mean age (p ¼ 0.002), diabetes mellitus (p ¼ 0.009), hypertension of more than five years duration (p ¼ 0.034), serum creatinine concentration of >1 mg per 100 ml (p ¼ 0.009), peripheral arterial disease (p ¼ 0.019), and significant CAD (p ¼ 0.037) were predictors of RAS.In the multivariate analysis, serum creatinine concentration (p ¼ 0.002), peripheral arterial disease (p ¼ 0.017), Two-vessel CAD (p ¼ 0.043), and Three-vessel CAD (p ¼ 0.007) were independent predictors of RAS. Areas under the non-crossing ROC curves revealed that a simple model incorporating two-vessel CAD and three-vessel CAD had an acceptable accuracy in predicting RAS.Please cite this article in press as: Sai CV, et al., Predictors of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease, Journal of Indian College of Cardiology (2015), http://dx.

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

Cited by 14 publications

References 43 publications

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

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

Renal Artery Stenosis and Acute Pulmonary Edema-A Possible Correlation beyond Pickering Syndrome

Predictors of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease

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