(Circulation. 1998;98:2866-2872.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports* |
Prospective Study of Atherosclerotic Disease Progression in the Renal Artery
From the Department of Surgery, Division of Vascular Surgery (M.T.C., R.E.Z., R.O.B., K.C.-G., D.E.S.) and Department of Medicine, Division of Nephrology (R.C.D.), The University of Washington School of Medicine, Seattle; Department of Internal Medicine (C.P.), University of Padua, Castelfranco Veneto Hospital, Padua, Italy; The Mountain-Whisper-Light Statistical Consulting (N.L.P.), Seattle, Wash; and University of New Mexico School of Medicine, Division of Vascular Surgery (M.J.T.), Albuquerque.
Correspondence to D. Eugene Strandness, Jr, MD, University of Washington, 1959 NE Pacific St, Department of Surgery, Box 356410, Seattle, WA 98195-6410. E-mail destrand{at}u.washington.edu
Background—The aim of this study was to determine the incidence of and the risk factors associated with progression of renal artery disease in individuals with atherosclerotic renal artery stenosis (ARAS).
Methods and Results—Subjects with 
1 ARAS were monitored with
serial renal artery duplex scans. A total of 295 kidneys in 170
patients were monitored for a mean of 33 months. Overall, the
cumulative incidence of ARAS progression was 35% at 3 years and 51%
at 5 years. The 3-year cumulative incidence of renal artery disease
progression stratified by baseline disease classification was 18%,
28%, and 49% for renal arteries initially classified as normal,
<60% stenosis, and 60% stenosis, respectively
(P=0.03, log-rank test). There were only 9 renal artery
occlusions during the study, all of which occurred in renal arteries
having 60% stenosis at the examination before the detection
of occlusion. A stepwise Cox proportional hazards model included 4
baseline factors that were significantly associated with the risk of
renal artery disease progression during follow-up: systolic
blood pressure 160 mm Hg (relative risk [RR]=2.1; 95%
CI, 1.2 to 3.5), diabetes mellitus (RR=2.0; 95% CI, 1.2 to 3.3), and
high-grade (>60% stenosis or occlusion) disease in either the
ipsilateral (RR=1.9; 95% CI, 1.2 to 3.0) or contralateral (RR=1.7;
95% CI, 1.0 to 2.8) renal artery.
Conclusions—Although renal artery disease progression is a frequent occurrence, progression to total renal artery occlusion is not. The risk of renal artery disease progression is highest among individuals with preexisting high-grade stenosis in either renal artery, elevated systolic blood pressure, and diabetes mellitus.
Key Words: atherosclerosis • kidney • arteries • stenosis
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