title: Is fibromuscular dysplasia underdiagnosed? A comparison of the prevalence of FMD seen in CORAL trial participants versus a single institution population of renal donor candidates.
abstract: Renal artery fibromuscular dysplasia (FMD) may be underdiagnosed. We evaluated the prevalence of FMD in CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) renal artery stent trial participants, in which FMD was an exclusion criterion for inclusion. We also evaluated the prevalence of FMD in a relatively healthy population of patients undergoing computed tomographic angiographic (CTA) screening for renal donor evaluation. All renal donor CTAs performed at our institution from January 2003 through November 2011 were retrospectively reviewed for the presence of FMD along with patient sex and age. These results were compared to angiographic core lab (ACL) findings for the CORAL trial. The CORAL ACL database contained 997 patients (mean age 69.3 years; 50% female). Fifty-eight (5.8%) CORAL trial patients (mean age 71.8 years; 75.9% female) demonstrated incidental FMD. The renal donor cohort included 220 patients (mean age 40.5 years; 64.5% female). Five (2.3%) demonstrated FMD (mean age 48.6 years; all female). The odds of FMD in the CORAL cohort were 2.65 times that seen in the renal donor cohort (95% CI: 1.12, 7.57). In C: onclusion, the 5.8% prevalence of renal artery FMD in the CORAL trial population, the presence of which was biased against, suggests underdiagnosis.
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA nicholasjhendricks@gmail.com.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Hendricks
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Angle
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Baheti
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Auh W
authors.initials: AW
authors.lastname: Park
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Stone
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.affiliation: Brown University, Providence, RI, USA.
authors.forename: Lance
authors.initials: L
authors.lastname: Dworkin
authors.affiliation: University of Toledo, Toledo, OH, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
authors.affiliation: Rhode Island Hospital, Providence, RI, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000792:Angiography / Q000379:methods; D046148:Donor Selection; D005260:Female; D005352:Fibromuscular Dysplasia / Q000175:diagnosis* / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015607:Stents; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods
keywords: fibromuscular dysplasia; renal artery