Atherosclerotic renovascular disease among hypertensive adults

被引:11
作者
Davis, Ross P.
Pearce, Jeffrey D.
Craven, Timothy E. [2 ]
Moore, Phillip S.
Edwards, Matthew S.
Godshall, Christopher J.
Hansen, Kimberley J. [1 ]
机构
[1] Wake Forest Univ, Sch Med, Div Surg Sci, Dept Vasc & Endovasc Surg, Winston Salem, NC 27157 USA
[2] Wake Forest Univ, Sch Med, Div Publ Hlth Sci, Winston Salem, NC 27157 USA
关键词
RENAL-ARTERY STENOSIS; DUPLEX SONOGRAPHY; ISCHEMIC NEPHROPATHY; NATURAL-HISTORY; BLOOD-PRESSURE; HILAR ANALYSIS; PROGRESSION; RATIONALE; PREVALENCE; DESIGN;
D O I
10.1016/j.jvs.2009.03.062
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose: This report describes the change in atherosclerotic renovascular disease (AS-RVD) among hypertensive adults referred for renal duplex sonography (RDS) scan. Methods: From Oct 1993 through July 2008, 20,994 patients had RDS at our center. A total of 434 hypertensive patients with two or more RDS exams without intervention comprised the study cohort. Patient demographics (blood pressures, medications, serum creatinine levels, and data from RDS) were collected. Analyses of longitudinal changes in Doppler scan parameters, blood pressures, and renal function were performed by fitting linear growth-curve models. After confirming the linearity of change in Doppler scan parameters among patients with variable number of studies, estimates of mean slopes were calculated using maximum likelihood techniques. For changes in renal function, quadratic growth curves were required to describe longitudinal change. Results. A total of 434 subjects (212 men [49%] and 222 women [51%]; mean age, 64.6 +/- 12.2 years) provided 1351 studies (mean, 3.2 +/- 2.4; range, 2 to 18) for 863 kidneys over a mean follow-up of 34.4 +/- 25.1 months. At baseline, 20.6% of kidneys demonstrated hemodynamically significant stenosis. On follow-up, 72 kidneys (9.1%) demonstrated anatomic progression of disease. A total of 54 kidneys (6.9%) progressed to significant stenosis and 18 (2.3%) progressed to occlusion. Controlling for progression of disease, baseline renal artery status demonstrated a strong association with baseline kidney length (P = .0006). Significant annualized change in renal length was observed (cm change/year +/- standard error of the mean [SEMI: 0.042 +/- 0.011; P = .0002) among both kidneys with and without critical disease at baseline, however, decline in length was significantly greater among kidneys exhibiting progression of renovascular disease (-0.152 +/- 0.028 cm/year; comparison of slopes between groups P = .0005). In the absence of progression, the presence or absence of critical renal artery stenosis at baseline did not affect the rate of decline in renal length. Fitted models for the natural log transform of serum creatinine demonstrated a significant increase during follow-up (P < .0001). No association was observed between change in serum creatinine and baseline renovascular disease status, or its progression. Conclusion:A total of 32% of hypertensive adults referred for RDS demonstrated hemodynamically significant renal artery stenosis. Regardless of the presence or absence of baseline disease, a small percentage of patients demonstrated anatomic progression of AS-RVD. A total of 9.1% demonstrated anatomic progression and 2.3% progressed to occlusion. Although anatomic progression of AS-RVD was associated with an increased rate of decline in renal length, progression did not predict a decline in excretory renal function. Intervention for AS-RVD should be selective and reserved for strict indications. (J Vasc Surg 2009;50:564-71.)
引用
收藏
页码:564 / 571
页数:8
相关论文
共 31 条
[1]  
Axelrod DA, 2003, J ENDOVASC THER, V10, P546, DOI 10.1583/1545-1550(2003)010<0546:PSOIUR>2.0.CO
[2]  
2
[3]  
Bax L, 2003, J NEPHROL, V16, P807
[4]   Risk of atrophy in kidneys with atherosclerotic renal artery stenosis [J].
Caps, MT ;
Zierler, RE ;
Polissar, NL ;
Bergelin, RO ;
Beach, KW ;
Cantwell-Gab, K ;
Casadei, A ;
Davidson, RC ;
Strandness, ED .
KIDNEY INTERNATIONAL, 1998, 53 (03) :735-742
[5]   Prospective study of atherosclerotic disease progression in the renal artery [J].
Caps, MT ;
Perissinotto, C ;
Zierler, RE ;
Polissar, NL ;
Bergelin, RO ;
Tullis, MJ ;
Cantwell-Gab, K ;
Davidson, RC ;
Strandness, DE .
CIRCULATION, 1998, 98 (25) :2866-2872
[6]   Surgical management of atherosclerotic renovascular disease [J].
Cherr, GS ;
Hansen, KJ ;
Craven, TE ;
Edwards, MS ;
Ligush, J ;
Levy, PJ ;
Freedman, BI ;
Dean, RH .
JOURNAL OF VASCULAR SURGERY, 2002, 35 (02) :236-245
[7]   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 [J].
Cooper, Christopher J. ;
Murphy, Timothy P. ;
Matsumoto, Alan ;
Steffes, Michael ;
Cohen, David J. ;
Jaff, Michael ;
Kuntz, Richard ;
Jamerson, Kenneth ;
Reid, Diane ;
Rosenfield, Kenneth ;
Rundback, John ;
D'Agostino, Ralph ;
Henrich, William ;
Dworkin, Lance .
AMERICAN HEART JOURNAL, 2006, 152 (01) :59-66
[8]  
*CTR MED MED SERV, MEDCAC M PERC TRANSL
[9]  
DENA RH, 1991, CURRENT CRITICAL PRO, V3, P302
[10]   Renovascular disease and the risk of adverse coronary events in the elderly - A prospective, population-based study [J].
Edwards, MS ;
Craven, TE ;
Burke, GL ;
Dean, RH ;
Hansen, KJ .
ARCHIVES OF INTERNAL MEDICINE, 2005, 165 (02) :207-213