The prevalence and clinical predictors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography

Abstract

Renal artery stenosis is an important cause of secondary hypertension as well as ischemic nephropathy. The purpose of this study was to determine the clinical predictors in patients with renal artery stenosis in a population referred for coronary angiography. From March 1998 to July 1999, 1459 patients undergoing coronary angiography for various indications were routinely screened for renal artery stenosis by undergoing abdominal aortography. Coronary angiography, carotid angiography, and abdominal aortography was performed via either the radial or the femoral approach. The data were analyzed retrospectively. Out of 1459 patients undergoing abdominal aortography, 158 (10.8%) were found to have significant renal artery stenosis with 24 of the patients having bilateral stenosis. Significant coronary artery diseases were found in 994 of the 1459 study population (68.1%), with 134 (13.5%) of these patients having concomitant renal artery stenosis. Multivariate logistic regression showed that extracranial carotid artery stenosis odds ratio [(OR) 4.89 (95% confidence interval 2.57-9.33), P < 0.001], peripheral artery disease [OR 4.64 (2.65-9.33), P < 0.001], renal insufficiency [OR 2.68 (1.43-5.02), P = 0.002], significant coronary artery disease [OR 2.01 (1.12-3.59), P = 0.019], hypercholesterolemia [OR 1.92 (1.07-3.43), P = 0.028], hypertension [OR 1.85 (1.16-2.95), P = 0.010], and old age (> 60 years) [OR 1.64 (1.01-2.64), P = 0.044] were significant clinical predictors of renovascular disease. The prevalence of indolent atherosclerotic renal artery stenosis is relatively high in selected groups of patients with high clincial risk factors for this underdiagnosed disease. Renal artery stenosis should be highly suspected in patients who have these risk factors because early detection of this disease may reverse the progression to chronic renal failure and end-stage renal disease.

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

“…We performed systematic RA in consecutive AMI patients, regardless of other risk factors suggesting RAS (severe hypertension, PAD, or abdominal bruits). Data showed concordant values of RAS prevalence in AMI (16.6%) to those reported in well‐recognized risk groups (suspected renovascular hypertension5, 30—14.1%, hypertension and diabetes mellitus31—17.1%, chronic CAD5, 32, 33—9.1% to 10.8%) but lower values than in patients with chronic heart failure34—54.1%, aortic abdominal aneurysm35—38%, end‐stage renal disease36—40.8%. Differences between reports are driven by inclusion of patients with different stages of atheromatous disease and inflammation.…”

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

“…Similar differences in groups have been found in other studies. [11][12][13][14][15][16][17][18][19] The higher rate of RAS among patients with a history of CABG in our study and that of Cohen et al 19 reflects a higher prevalence among patients with multi-vessel CAD. This finding may certify that RAS is a manifestation of diffuse atherosclerosis and has a higher prevalence in those with CAD and PAD.…”

“…Among severe RAS patients with differentiated vessel involvement, the prevalence was 16.6, 20.1 and 38.2%, respectively. In the study of Park et al, 13 the prevalence of significant RAS ranged from 19.6% in patients with 1-VD to 41.8% in those with 3-VD. Similar differences in groups have been found in other studies.…”

“…[7][8][9] The reported prevalence of significant RAS (X50%) among patients undergoing coronary angiography ranges from 6.2% to as high as 28%. 2,[8][9][10][11][12][13][14][15][16][17][18] A positive association between the presence and severity of RAS and CAD has been described, [11][12][13]16,18,19 and the presence of RAS has been associated with poor cardiovascular outcome. 9,[20][21][22] There is growing evidence that a high percentage of significant atherosclerotic RAS is clinically indolent.…”

“…9,[20][21][22] There is growing evidence that a high percentage of significant atherosclerotic RAS is clinically indolent. [13][14][15][16] In recent years, efforts have been made to determine the prevalence of RAS and its predictors among patients with peripheral and coronary artery disease. 20,[23][24][25] Attention has also been paid to the role of ethnicity in the prevalence of RAS.…”