Incidental atherosclerotic renal artery stenosis diagnosed at cardiac catheterization: no difference in kidney function with or without stenting.
BACKGROUND
The long-term kidney function of patients with atherosclerotic renal artery stenosis (ARAS) diagnosed incidentally at the time of cardiac catheterization is not well described despite the increasingly common practice of assessing these vessels at the time of cardiac investigation.


METHODS
This is a retrospective analysis of a cohort identified prospectively at the time of non-emergent coronary angiography. Those with >or=50% ARAS were managed medically and underwent stenting if recommended by their nephrologist and/or cardiologist. Longitudinal regression analysis was used to compare the annualized change in estimated glomerular filtration rate (GFR) in stented and unstented patients. Cox regression analysis was used to determine the predictors of a decline in GFR by >or=25%.


RESULTS
Of 140 patients, 67 (48%) were stented, mostly for preservation of kidney function (70.1%) and/or resistant hypertension (53.7%). Median follow-up time was 943 days. Stented patients were younger, had higher systolic blood pressure and more severe ARAS. The adjusted rate of change in GFR was -1.49 (95% CI -2.33 to -0.65) ml/min/1.73 m(2)/year in the unstented group, and -1.48 (95% CI -2.34 to -0.62) ml/min/1.73 m(2)/year in the stented group (p = 0.99). A decline of GFR >or=25% occurred in 42 (30%) patients; no patient required dialysis. Only the presence of cereberovascular disease was associated with this outcome (hazard ratio 2.52, 95% CI 1.56-5.41).


CONCLUSIONS
We were unable to demonstrate a benefit or harm of renal artery stenting for ARAS, thus further increasing the uncertainty of the significance of these lesions and how they are best managed.
Zalunardo
Nadia
N
Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. nadia.zalunardo@vch.ca
Rose
Caren
C
Starovoytov
Andrew
A
Djurdjev
Ognjenka
O
Fox
Rebecca
R
Taylor
Paul
P
Duncan
John A
JA
Buller
Christopher E H
CE
Levin
Adeera
A
D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008954:Models, Biological; D012044:Regression Analysis; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D015607:Stents; D016896:Treatment Outcome