title: Extrarenal atherosclerotic disease blunts renal recovery in patients with renovascular hypertension.
abstract: BACKGROUND
  Atherosclerotic renovascular disease (ARVD) is associated with high rates of coronary events and predicts mortality among patients with coronary artery disease (CAD). However, the impact of coronary atherosclerosis on renal outcomes after revascularization of ARVD is unclear. We hypothesized that CAD negatively impacts renal functional outcomes among patients with ARVD undergoing renal artery revascularization.
  
  
  METHODS
  Patients with ARVD who underwent echocardiography at Mayo Clinic, Rochester, Minnesota, USA between 2004 and 2012 were identified retrospectively and included if they had ejection fraction more than 50%. Renal and overall outcomes were compared among atherosclerotic renovascular disease patients with coronary artery disease (ARVD-C, n = 75) and without coronary artery disease (ARVD, n = 56), within 1 year from initial revascularization and included blood pressure control, renal function, and incident cardiovascular/cerebrovascular events.
  
  
  RESULTS
  Degree of renal artery stenosis was similar in both groups. ARVD-C had higher prevalence of diabetes, peripheral artery disease (PAD), and cerebrovascular disease, and lower baseline renal function. Risk of developing end-stage renal disease was higher in ARVD-C (11 vs. 2%, P = 0.05). Despite better control of blood pressure and cholesterol levels, renal function postrevascularization worsened in 15% of ARVD-C compared with 2% of ARVD (P = 0.01). Differences in clinical outcomes remained statistically significant after adjustment for covariables, including sex, baseline blood pressure, renal function, underlying diabetes, cholesterol levels, and medications. Similar differences in clinical outcomes were also associated with PAD and cerebrovascular disease.
  
  
  CONCLUSIONS
  CAD in patients with ARVD is a predictor of worse outcomes after renal revascularization, likely reflecting diffuse atherosclerotic disease. Further studies are needed to develop strategies to manage patients with vascular comorbidities and improve their outcomes.
authors.affiliation: aDivisions of Nephrology and Hypertension bCardiovascular Diseases cVascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kirandeep K
authors.initials: KK
authors.lastname: Khangura
authors.forename: Alfonso
authors.initials: A
authors.lastname: Eirin
authors.forename: Garvan C
authors.initials: GC
authors.lastname: Kane
authors.forename: Sanjay
authors.initials: S
authors.lastname: Misra
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Textor
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis; D003251:Constriction, Pathologic / Q000473:pathology*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications / Q000401:mortality / Q000473:pathology*; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000473:pathology*; D012078:Renal Artery Obstruction / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome