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Prevalence of renal artery stenosis in patients undergoing cardiac catheterization

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An Erratum to this article was published on 26 June 2011

Abstract

To investigate the prevalence of significant renal artery stenosis (RAS ≥50%), and to identify clinical predictors for significant RAS in patients with an elevated cardiovascular risk, such as those affected by ischemic heart disease. In patients with an elevated cardio-vascular risk, both atherosclerotic renovascular disease and coronary artery disease (CAD) are likely to occur. Prospectively from April 2007 to March 2008, all consecutive patients with ischemic heart disease undergoing non-emergent cardiac catheterization were also evaluated for atherosclerotic RAS by renal arteriography. A RAS ≥50% was considered as significant. A total of 1,298 patients underwent cardiac and renal angiography. Significant RAS was found in 70 out of 1,298 patients (5.4%). The presence of peripheral vascular disease, eGFR <67 ml/min/1.73 m2, age >66 years, dyslipidemia, CAD severity and pulse pressure >52 mmHg were independent clinical predictors of significant RAS, and jointly produced a ROC AUC of 0.79 (95% CI 0.73–0.85, P < 0.001). Based on these data, a prediction rule for significant RAS was developed, and it showed an adequate predictive performance with 64% sensitivity and 82% specificity. In a large cohort of patients undergoing coronary angiography, significant RAS is a relatively rare comorbidity (5.4%). A model based on simple clinical variables may be useful for the clinical identification of high CV risk patients who may be suitable for renal arteriography at the time of cardiac catheterization.

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References

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

    Article  PubMed  CAS  Google Scholar 

  2. Wright JR, Shurrab AE, Cooper A, Kalra PR, Foley RN, Kalra PA (2005) Left ventricular morphology and function in patients with atherosclerotic renovascular disease. J Am Soc Nephrol 16:2746–2753

    Article  PubMed  Google Scholar 

  3. Harding MB, Smith LR, Himmelstein SI et al (1992) Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol 2:1608–1616

    PubMed  CAS  Google Scholar 

  4. Rihal CS, Textor SC, Breen JF et al (2002) Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. Mayo Clin Proc 77:309–318

    Article  PubMed  Google Scholar 

  5. Buller CE, Nogareda JG, Ramanathan K et al (2004) The profile of cardiac patients with renal artery stenosis. J Am Coll Cardiol 43:1606–1613

    Article  PubMed  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  7. Olin JW, Melia M, Young JR, Graor RA, Risius B (1990) Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Am J Med 88:46N–51N

    Article  PubMed  CAS  Google Scholar 

  8. Mui KW, Sleeswijk M, van den Hout H, van Baal J, Navis G, Woittiez AJ (2006) Incidental renal artery stenosis is an independent predictor of mortality in patients with peripheral vascular disease. J Am Soc Nephrol 17:2069–2074

    Article  PubMed  Google Scholar 

  9. De Mast Q, Beutler JJ (2009) The prevalence of atherosclerotic renal artery stenosis in risk groups: a systematic literature review. J Hypertens 27:1333–1340

    Article  PubMed  CAS  Google Scholar 

  10. Hirsch AT, Haskal ZJ, Hertzer NR et al (2006) ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). Circulation 113:e463–e654

    Article  PubMed  Google Scholar 

  11. White CJ, Jaff MR, Haskal ZJ et al (2006) Indications for Renal Arteriography at the Time of Coronary Arteriography A Science Advisory From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Councils on Cardiovascular Radiology and Intervention and on Kidney in Cardiovascular Disease. Circulation 114:1892–1895

    Article  PubMed  Google Scholar 

  12. Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group. Ann Intern Med 130:461–470

    Article  PubMed  CAS  Google Scholar 

  13. Tripepi G, Jager KJ, Dekker FW, Zoccali C (2009) Diagnostic methods 2: receiver operating characteristic (ROC) curves. Kidney Int 76(3):252–256

    Article  PubMed  Google Scholar 

  14. Steyerberg EW (2009) In: Clinical prediction model. A practical approach to development, validation and updating. Springer, New York, pp 94–96

  15. White CJ, Olin JW (2009) Diagnosis and management of atherosclerotic renal artery stenosis: improving patients selection and outcomes. Nat Clin Pract Cardiovasc Med 6(3):176–190

    Article  PubMed  Google Scholar 

  16. Przewlocki T, Kablak-Ziembicka A, Tracz W et al (2008) Prevalence and prediction of renal artery stenosis in patients with coronary and supraaortic artery atherosclerotic disease. NDT 23:580–585

    PubMed  Google Scholar 

  17. Cohen MG, Pascua JA, Garcia-Ben M et al (2005) A simple prediction rule for significant renal artery stenosis in patients undergoing cardiac catheterization. Am Heart J 150:1204–1211

    Article  PubMed  Google Scholar 

  18. Krijnen P, van Jaarsveld BC, Steyerberg EW et al (1998) A clinical prediction rule for renal artery stenosis. Ann Intern Med 129:705–711

    Article  PubMed  CAS  Google Scholar 

  19. Ducher M, Cerutti C, Mounier-Vehier C et al (2005) How to limit screening of patients with atheromatous renal artery stenosis in two-drug resistant hypertension. J Nephrol 18:161–165

    PubMed  Google Scholar 

  20. Wilcox CS (1998) Screening for renal artery stenosis: are scans more accurate than clinical criteria. Ann Intern Med 129:738–740

    Article  PubMed  CAS  Google Scholar 

  21. Kobo Ofer, Hammoud M, Makhoul N, Omary H, Rosenschein U (2010) Screening, diagnosis, and treatment of renal artery stenosis by percutaneous transluminal renal angioplasty with stenting. IMAJ 12:140–143

  22. El-Mawardy R, Ghareeb MA, Mahdy MM, Sabet SS, Nammas WM (2008) Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing elective coronary procedures. J Clin Hypertens 10:844–849

    Article  Google Scholar 

  23. The ASTRAL investigators (2009) Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 361:1953–1962

    Google Scholar 

  24. Bax L, Woittiez AJ, Kouwenberg HJ et al (2009) Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function. A randomized trial. Ann Intern Med 150:840–848

    Google Scholar 

  25. White CJ (2010) Kiss my astral: one seriously flawed study of renal stenting after another. Catheter Cardiovasc Interv 75(2):305–307

    Article  PubMed  Google Scholar 

  26. White CJ (2009) Fight the stupids! Catheter Cardiovasc Interv 74(3):530–532

    Article  PubMed  Google Scholar 

  27. Cooper CJ, Murphy TP, Matsumoto A, Steffes M, Cohen DJ, Jaff M, Kuntz R, Jamerson K, Reid D, Rosenfield K, Rundback J, D’Agostino R, Henrich W, Dworkin L (2006) Stent revascularization for the prevention of cardiovascular and renal events among patients with renal artery stenosis and systolic hypertension: rationale and design of the CORAL trial. Am Heart J 152(1):59–66

    Article  PubMed  Google Scholar 

  28. Marcantoni C, Zanoli L, Rastelli S, Tripepi G, Matalone M, Di Landro D, Scandura S, Tamburino C, Zoccali C, Castellino P (2009) Stenting of renal artery stenosis in coronary artery disease (RAS-CAD) study: a prospective, randomized trial. J Nephrol 22(1):13–16

    PubMed  Google Scholar 

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Acknowledgments

The authors disclose any relationship with industry and financial associations and declare the absence of conflicts of interest.

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Authors and Affiliations

  1. Division of Nephrology, Cannizzaro Hospital, Catania, Italy

    Marcantoni Carmelita

  2. Internal Medicine, University of Catania, Catania, Italy

    Rastelli Stefania, Zanoli Luca & Castellino Pietro

  3. CNR-IBIM, Reggio, Calabria, Italy

    Tripepi Giovanni

  4. Division of Cardiology, University of Catania, Catania, Italy

    Di Salvo Marilena, Monaco Sergio, Sgroi Carmelo, Capodanno Davide & Tamburino Corrado

Authors
  1. Marcantoni Carmelita
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  2. Rastelli Stefania
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  3. Zanoli Luca
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  4. Tripepi Giovanni
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  5. Di Salvo Marilena
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  6. Monaco Sergio
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Correspondence to Marcantoni Carmelita.

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Carmelita, M., Stefania, R., Luca, Z. et al. Prevalence of renal artery stenosis in patients undergoing cardiac catheterization. Intern Emerg Med 8, 401–408 (2013). https://doi.org/10.1007/s11739-011-0624-5

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  • DOI: https://doi.org/10.1007/s11739-011-0624-5

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