Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis.
BACKGROUND
Although atherosclerotic renovascular disease is increasingly recognized in chronic kidney disease, few national level studies have examined its clinical epidemiology.


METHODS
Claims data from a 5% random sample of the United States Medicare population were used to select patients without atherosclerotic renovascular disease in the 2 years preceding December 31, 1999 (N= 1,085,250), followed until December 31, 2001.


RESULTS
The incidence of atherosclerotic renovascular disease was 3.7 per 1000 patient-years. Major antecedent associations [P < 0.05, with adjusted hazards ratios (HR) > 1.5] included chronic kidney disease (adjusted HR 2.54), hypertension (2.42), peripheral vascular disease (2.00), and atherosclerotic heart disease (1.70). Adverse event rates after incident atherosclerotic renovascular disease greatly exceeded those in the general population (P < 0.0001): atherosclerotic heart disease, 303.9 per 1000 patient-years (vs. 73.5 in the general population); peripheral vascular disease, 258.6 (vs. 52.2); congestive heart failure, 194.5 (vs. 56.3); cerebrovascular accident or transient ischemic attack, 175.5 (vs. 52.9); death, 166.3 (vs. 63.3); and renal replacement therapy, 28.8 (vs. 1.3). Among atherosclerotic renovascular disease patients, 16.2% underwent a renal revascularization procedure, percutaneously in 96%. Revascularization was not associated with renal replacement therapy, congestive heart failure, or death but was associated with atherosclerotic heart disease (adjusted HR 1.42) (P= 0.004) and peripheral vascular disease (adjusted HR 1.38) (P= 0.002).


CONCLUSIONS
Atherosclerotic renovascular disease is strongly associated with cardiovascular disease, both past and future. Absolute cardiovascular risk exceeds that of renal replacement therapy. Renal revascularization is used selectively and shows inconsistent associations with cardiovascular outcomes, renal replacement therapy, and death.
Kalra
Philip A
PA
Department of Renal Medicine, Hope Hospital, Salford, United Kingdom.
Guo
Haifeng
H
Kausz
Annamaria T
AT
Gilbertson
David T
DT
Liu
Jiannong
J
Chen
Shu-Cheng
SC
Ishani
Areef
A
Collins
Allan J
AJ
Foley
Robert N
RN
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D012078:Renal Artery Obstruction / Q000453:epidemiology* / Q000628:therapy; D012079:Renal Circulation; D012307:Risk Factors; D014481:United States / Q000453:epidemiology