Renal Vascular Disease Causing End-Stage Renal Disease, Incidence, Clinical Correlates, and Outcomes: A 20-Year Clinical Experience

Mailloux, Lionel U.; Napolitano, Barbara; Bellucci, Alessandro; Vernace, Melchiore A.; Wilkes, Barry M.; Mossey, Robert T.

doi:10.1016/s0272-6386(12)80223-x

Cited by 332 publications

(194 citation statements)

References 16 publications

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“…7,8 Renovascular disease is a significant cause of renal failure, with its presence having the worst effect on prognosis. 5 Mailloux et al, 6 detailing 683 patients on hemodialysis, demonstrated that patients with renal artery stenosis as the cause of the end-stage renal disease had the poorest survival (5-and 10-year survivals of 18% and 5%, respectively) among all causes of end-stage renal disease other than diabetic glomerulosclerosis. Although renal artery stenosis is a well-recognized cause of secondary hypertension, revascularization has until recently been looked on with skepticism as a method to preserve renal function in patients with chronic renal insufficiency, despite the demonstration that restoration of renal artery blood flow has led to termination of dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Although surgical revascularization has cured or improved blood pressure control, preserved or stabilized renal function, 9 -15 and reversed end-stage renal failure, 16 -18 its morbidity and mortality rates have been higher than those of stent revascularization. 19 -24 Stent revascularization has created the perception of superiority to balloon angioplasty [25][26][27][28][29][30][31] and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data.…”

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confidence: 99%

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Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

et al. 1998

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Background-Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. Methods and Results-Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for Ն6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166Ϯ26 to 148Ϯ22 mm Hg and from 86Ϯ14 to 80Ϯ11 mm Hg, respectively; PϽ0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74Ϯ4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92Ϯ4%) baseline renal function, fair (74Ϯ7%) in those with mildly impaired renal function, and poor (52Ϯ7%) in patients with elevated baseline creatinine levels (Ն2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. Conclusions-Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival. (Circulation. 1998;98:642-647.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

et al. 1998

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“…[2][3][4] RAS is the most common potentially reversible disorder leading to renal replacement therapy. 5,6 Moreover, the presence of RAS has been independently associated with increased mortality, particularly in patients with coronary artery disease (CAD) and ESRD. [7][8][9] The reported prevalence of significant RAS (X50%) among patients undergoing coronary angiography ranges from 6.2% to as high as 28%.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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Renal artery stenosis (RAS) is a major comorbid condition in patients with coronary artery disease (CAD). Although the reported prevalence of significant RAS among patients undergoing coronary angiography varies from 6.2 to 28% in Western countries, little information is available on the prevalence and predictors of RAS in Middle Eastern countries. From April 2007 to May 2008, 732 hypertensive patients with suspected CAD immediately after selective coronary angiography underwent abdominal aortography with or without selective renal angiography. Coronary angiography revealed stenosis of X50% in at least one of the main coronary vessels in 434 (59.3%) patients, including 100 (13.7%) cases with single-vessel CAD, 114 (15.6%) with two-vessel CAD and 220 (30.1%) with three-vessel CAD. Significant RAS was present in 87 patients (11.9%), severe (X75%) RAS in 35 patients (4.8%) and bilateral RAS in 37 patients (5.1%). Higher serum creatinine level, severity of CAD, history of coronary artery bypass graft surgery (CABG), congestive heart failure, and pulmonary edema together with atrial fibrillation were the most powerful predictors of significant RAS. In multivariate logistic regression analysis, three-vessel CAD (odds ratio 1.61, 95% confidence interval (1.36-1.91), Po0.001), history of CABG (odds ratio 4.40, 95% confidence interval (1.17-16.5), P¼0.028) and serum creatinine level of 41.2 mg per 100 ml (odds ratio 2.12, 95% confidence interval (1.09-4.12), P¼0.026) were the most powerful predictors of significant RAS. The prevalence of RAS in our patients was similar to that reported in the Western countries. The presence of multi-vessel CAD or a history of CABG along with a higher serum creatinine level in hypertensive patients undergoing coronary angiography was found to be a risk factor for RAS.

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“…6,26 Tal complicação pôde ser também observada em nosso estudo, visto que alguns pacientes já estavam em tratamento conservador para doença renal crônica e alguns outros já apresentavam alterações dos níveis séricos de creatinina, indicando uma possível evolução desfavorável da função renal. Estima-se que cerca de 12% a 16% dos pacientes com insuficiência renal crônica terminal tenham como causa de lesão renal a estenose de artéria renal, provocando nefropatia isquêmica, principalmente quando a estenose é bilateral [27][28][29] .…”

Section: Doença Aterosclerótica Multiarterial Em Pacientes Hipertensosunclassified

Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis

Neves¹,

Oliveira²,

Oliveira³

et al. 2012

Jornal Brasileiro De Nefrologia

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Renal Vascular Disease Causing End-Stage Renal Disease, Incidence, Clinical Correlates, and Outcomes: A 20-Year Clinical Experience

Cited by 332 publications

References 16 publications

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

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

Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis

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