TY - JOUR
T1 - Outcomes of atherosclerotic renal artery stenosis managed without revascularization
AU - Chábová, Vera
AU - Schirger, Alexander
AU - Stanson, Anthony W.
AU - McKusick, Michael A.
AU - Textor, Stephen C.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2000
Y1 - 2000
N2 - Objective: To determine how often patients with renal artery stenosis (RAS) managed without revascularization progress to accelerated hypertension and/or renal failure. Patients and Methods: We examined the outcomes of 68 patients (mean ± SEM age, 71.8±0.9 years) with highgrade (>70%) RAS identified between 1989 and 1993 who were treated without renal revascularization for at least 6 months after angiography. The time to last follow-up averaged 38.9±2.8 months. Other vascular beds were affected in 66 of the 68 patients. End points were revascularization, nephrectomy, dialysis, or death. Results: The mean±SEM serum creatinine level rose from 1.4±0.1 to 2.0±0.2 mg/dL (P<.001). Mean±SEM blood pressure did not change (157±3/83±2 vs 155±3/79±2 mm Hg), but the need (mean±SEM) for medication increased from 1.6±0.1 to 1.9±0.1 drugs (P=.02). Four patients (5.8%) eventually underwent renal revascularization for refractory hypertension (1 patient), for progressive stenosis (1 patient), and during aortic reconstruction (2 patients). One additional patient underwent nephrectomy to improve blood pressure control. Five others (7.4%) developed end-stage renal disease (ESRD) for reasons other than progressive vascular disease, namely, diabetes (3 patients), atheroemboli (1 patient), and contrast toxicity without RAS progression (1 patient). In 1 further case, the reason for ESRD was unknown, and it may have been caused by vascular occlusion. During follow-up, 19 patients died of unrelated causes, including myocardial infarction and stroke. Conclusions: These data indicate that antihypertensive medication requirements increased and renal function deteriorated modestly in a subset of patients with atherosclerotic RAS managed initially without vascular intervention. Many achieved stable blood pressure for many years. Deterioration of renal function and mortality risk were greatest in patients with bilateral stenosis or stenosis to a solitary functioning kidney. These results reinforce then need for meticulous follow-up for disease progression but underscore the role of competing risks and high mortality from other cardiovascular diseases, which primarily determine the outcomes in patients with RAS and widespread atherosclerotic disease.
AB - Objective: To determine how often patients with renal artery stenosis (RAS) managed without revascularization progress to accelerated hypertension and/or renal failure. Patients and Methods: We examined the outcomes of 68 patients (mean ± SEM age, 71.8±0.9 years) with highgrade (>70%) RAS identified between 1989 and 1993 who were treated without renal revascularization for at least 6 months after angiography. The time to last follow-up averaged 38.9±2.8 months. Other vascular beds were affected in 66 of the 68 patients. End points were revascularization, nephrectomy, dialysis, or death. Results: The mean±SEM serum creatinine level rose from 1.4±0.1 to 2.0±0.2 mg/dL (P<.001). Mean±SEM blood pressure did not change (157±3/83±2 vs 155±3/79±2 mm Hg), but the need (mean±SEM) for medication increased from 1.6±0.1 to 1.9±0.1 drugs (P=.02). Four patients (5.8%) eventually underwent renal revascularization for refractory hypertension (1 patient), for progressive stenosis (1 patient), and during aortic reconstruction (2 patients). One additional patient underwent nephrectomy to improve blood pressure control. Five others (7.4%) developed end-stage renal disease (ESRD) for reasons other than progressive vascular disease, namely, diabetes (3 patients), atheroemboli (1 patient), and contrast toxicity without RAS progression (1 patient). In 1 further case, the reason for ESRD was unknown, and it may have been caused by vascular occlusion. During follow-up, 19 patients died of unrelated causes, including myocardial infarction and stroke. Conclusions: These data indicate that antihypertensive medication requirements increased and renal function deteriorated modestly in a subset of patients with atherosclerotic RAS managed initially without vascular intervention. Many achieved stable blood pressure for many years. Deterioration of renal function and mortality risk were greatest in patients with bilateral stenosis or stenosis to a solitary functioning kidney. These results reinforce then need for meticulous follow-up for disease progression but underscore the role of competing risks and high mortality from other cardiovascular diseases, which primarily determine the outcomes in patients with RAS and widespread atherosclerotic disease.
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U2 - 10.1016/s0025-6196(11)64210-9
DO - 10.1016/s0025-6196(11)64210-9
M3 - Article
C2 - 10807070
AN - SCOPUS:0034065155
SN - 0025-6196
VL - 75
SP - 437
EP - 444
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 5
ER -