Skip to main content
Log in

Prevalence and Predictors of Renal Artery Stenosis in Patients with Coronary Artery Disease

  • Published:
International Journal of Angiology

Abstract

Renal artery stenosis (RAS) is a strong independent predictor of mortality in patients with coronary artery disease (CAD). The study aimed to determine the prevalence of RAS in patients with significant CAD in order to develop and validate a score predicting RAS. Three hundred consecutive patients (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of 50% or more. Univariate and multivariate analyses were performed comparing patients with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS. The score was internally validated in patients randomly selected from the entire study group (validation group; n = 103), using ROC curves and the Hosmer–Lemeshow goodness-of-fit test. Twenty-seven patients (9%) had a significant RAS. Multivariate analysis showed that age over 65 years (OR = 4.1%, 95% CI = 1.6-10.3, p = 0.003) and hypertension (OR = 3.1, 95% CI = 1.2–7.7, p = 0.015) were independent predictors of RAS. The predictive score including these two variables and three others (female gender, renal and insufficiency, and more than 2- or 3-vessel disease) ranged from 0 to 7. Internal validation showed a good performance (ROC curve = 0.79 and χ2 Lemeshow = 3.45). For a score of less than 2, the negative predictive value is 98%. The rate of significant RAS in patients with significant CAD was 9%. The performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References

  1. Safian RD, Textor SC (2001) Renal-artery stenosis. N Engl J Med 344:431–442

    Article  CAS  PubMed  Google Scholar 

  2. Valabhji J, Robinson S, Poulter C, Robinson AC, Kong C, Henzen C, Gedroyc WM, Feher MD, Elkeles RS (2000) Prevalence of renal artery stenosis in subjects with type 2 diabetes and coexistent hypertension. Diabetes Care 23:539–543

    CAS  PubMed  Google Scholar 

  3. Courreges JP, Bacha J, Aboud E, Pradier P (2000) Prevalence of renal artery stenosis in type 2 diabetes. Diabetes Metab 26:90–96

    PubMed  Google Scholar 

  4. Missouris CG, Papavassiliou MB, Khaw K, Hall T, Belli AM, Buckenham T, MacGregor GA (1998) High prevalence of carotid artery disease in patients with atheromatous renal artery stenosis. Nephrol Dial Transplant 13:945–948

    CAS  PubMed  Google Scholar 

  5. Bolad IA, Breen J, Rogers P, Partridge J, Banner NR (2002) Prevalence and significance of renal artery stenosis and abdominal aortic atherosclerosis early after heart transplantation. Transplant Proc 34:3236–232

    Article  CAS  PubMed  Google Scholar 

  6. Ramirez G, Bugni W, Farber SM, Curry AJ (1987) Incidence of renal artery stenosis in a population having cardiac catheterization. South Med J 80:734–737

    CAS  PubMed  Google Scholar 

  7. Hardhing MB, Smith LR, Himmelstehi SI, Harrison K, Phillips HR, Schwab S J, Hermiller JB, Davidson CJ, Bashore TM (1992) Renal artery stenosis: prevalence and associated risk factors hi patients undergoing routine cardiac catheterization. J Am Soc Nephrol 2:1608–1616

    Google Scholar 

  8. Jean WJ, al-Bitar I, Zwicke DL, Port SC, Schmidt DH, Bajwa TK (1994) High incidence of renal artery stenosis hi patients with coronary artery disease. Cathet Cardiovasc Diagn 32:8–10

    CAS  PubMed  Google Scholar 

  9. Siogas C, Goudevenos J, Pappas S, Foussas S, Graekas G, Siamopoulos K, Sideris D (1996) Usefulness of renal arteriography following coronary angiography. J Invasive Cardiol 8:223–227

    PubMed  Google Scholar 

  10. Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR, Stack RS, Conlon PJ (1998) Progression of renal artery stenosis in patients undergoing cardiac catheterization. Am Heart J 136:913–918

    Article  CAS  PubMed  Google Scholar 

  11. Conlon PJ, Little MA, Pieper K, Mark DB (2001) Severity of renal vascular disease predicts mortality hi patients undergoing coronary angiography. Kidney Int 60:1490–1497

    Article  CAS  PubMed  Google Scholar 

  12. Shen Z, Shang Y, Zhu W (2001) The prevalence of renal artery stenosis in patients with coronary artery disease. Zhonghua Nei Ke Za Zhi 40:521–524

    CAS  PubMed  Google Scholar 

  13. Alhaddad IA, Blum S, Heller EN, Beato MA, Bhalodkar NC, Keriaky GE, Brown EJ Jr (2001) Renal artery stenosis in minority patients undergoing diagnostic cardiac catheterization: prevalence and risk factors. J Cardiovasc Pharmacol Ther 6:147–153

    CAS  PubMed  Google Scholar 

  14. Yamashita T, Ito F, Iwakiri N, Mitsuyama H, Fujii S, Kitabatake A (2002). Prevalence and predictors of renal artery stenosis in patients undergoing cardiac catheterization. Hypertens Res 25:553–557

    Article  PubMed  Google Scholar 

  15. Weber–Mzell D, Kotanko P, Schumacher M, Klein W, Skrabal F (2002) Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease. Eur Heart J 23:1684–1691

    CAS  PubMed  Google Scholar 

  16. Rihal CS, Textor SC, Breen JF, McKusick MA, Grill DE, Hallett JW, Hohnes DR Jr (2002) Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. Mayo Clin Proc 77:309–316

    PubMed  Google Scholar 

  17. Aqel RA, Zoghbi GJ, Baldwin SA, Auda WS, Calhoun DA, Coffey CS, Perry GJ, Iskandrian AE (2003) Prevalence of renal artery stenosis in high-risk veterans referred to cardiac catheterization. J Hypertens 21:1157–1162

    CAS  PubMed  Google Scholar 

  18. Saleh AA, Bustami BB (2004) Prevalence of renal artery stenosis in patients undergoing routine cardiac catheterization. Saudi Med J 25:52–54

    PubMed  Google Scholar 

  19. Buller CE, Nogareda JG, Ramanathan K, Ricci DR, Djurdjev O, Tinckam KJ, Penn EM, Fox RS, Stevens LA, Duncan JA, Levin A (2004) The profile of cardiac patients with renal artery stenosis. J Am Coll Cardiol 43:1606–1613

    Article  PubMed  Google Scholar 

  20. Vetrovec GW, Landwher DM, Edwards VL (1989) Incidence of renal artery stenosis in hypertensive patients undergoing coronary angiography. J Interv Cardiol 2:69–76

    Google Scholar 

  21. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    CAS  PubMed  Google Scholar 

  22. Wachtell K, Ibsen H, Olsen MH, Laybourn C, Christoffersen JK, Norgaard HH, Mantoni MY, Lund JO (1997) Occurrence of renal artery stenosis in patients with peripheral arteriosclerosis and hypertension. Ugeskr Laeger 159:6822–6824

    CAS  PubMed  Google Scholar 

  23. Louie J, Isaacson JA, Zierler RE, Bergelin RO, Strandness DE, Jr (1994) Prevalence of carotid and lower extremity arterial disease in patients with renal artery stenosis. Am J Hypertens 7:436–439

    CAS  PubMed  Google Scholar 

  24. Wang Y, Ho DS, Chen WH, Wang YQ, Lam WF, Shen ZJ, Lu CZ, Chui (2003) Prevalence and predictors of renal artery stenosis in Chinese patients with coronary artery disease. Intern Med J 33:280–285

    Article  CAS  PubMed  Google Scholar 

  25. Gross CM, Kramer J, Waigand J, Uhlich F, Olthoff H, Luft FC, Dietz (1998) Ostial renal artery stent placement for atherosclerotic renal artery stenosis in patients with coronary artery disease. Cathet Cardiovasc Diagn 45:1–8

    Article  CAS  PubMed  Google Scholar 

  26. Caps MT, Perissinotto C, Zierler RE, Polissar NL, Bergelin RO, Tullis MJ, Cantwell–Gab K, Davidson RC, Strandness DE Jr (1998) Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int 53:735–742

    Article  CAS  PubMed  Google Scholar 

  27. Stack R (1999) Renal artery stenosis: under-diagnosed and under-treated in the cardiac patient? J Invasive Cardiol 11:103–106

    CAS  PubMed  Google Scholar 

  28. Harden PN, MacLeod MJ, Rodger RS, Baxter GM, Connell JM, Dominiczak AF, Junor BJ, Briggs JD, Moss JG (1997) Effect of renal-artery stentuig on progression of renovascular renal failure. Lancet 349:1133–1136

    Article  CAS  PubMed  Google Scholar 

  29. Gray BH, Olin JW, Childs MB, Sullivan TM, Bacharach JM (2002) Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure. Vasc Med 7:275–279

    Article  PubMed  Google Scholar 

  30. Radermacher J (2002) Echo-Doppler to predict the outcome for renal artery stenosis. J Nephrol 15 Suppl 6:S69–76

    PubMed  Google Scholar 

Download references

Acknowledgment.

The authors thank Dr. Semir Nouira for his help in developing the scoring system.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Faouzi Addad M.D..

About this article

Cite this article

Addad, F., Betbout, F., Farhat, M.B. et al. Prevalence and Predictors of Renal Artery Stenosis in Patients with Coronary Artery Disease. Int J Angiol 14, 81–86 (2005). https://doi.org/10.1007/s00547-005-2017-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00547-005-2017-y

Keywords

Navigation