RENOVASCULAR DISEASE IN OLDER PATIENTS BEGINNING RENAL REPLACEMENT THERAPY

Renovascular disease (RVD) in order patients can cause progressive ren al insufficiency and even end-stage renal disease (ESRD). The frequenc y of this clinical problem is not well defined. Renal duplex sonograph y (RDS) correctly identifies the presence of RVD with an overall accur acy of approximately 95%. Therefore, the purpose of this study was to utilize RDS as a noninvasive tool to identify the presence of critical RVD (greater than or equal to 60% diameter-reducing stenosis or occlu sion) in patients 50 years of age or older beginning renal replacement therapy. A total of 53 consecutive participating patients were prospe ctively interrogated. Complete interrogations occurred in 45 of the 53 patients (85%), and 92 of the 103 kidneys (89%). Critical RVD was not ed in 10 of 45 patients (22%). RVD was bilateral in 5 patients, unilat eral in 5 patients, and there were 4 renal artery occlusions noted. Al l patients with critical RVD were white (10 of 25 white patients or 40 %). Total pack years of smoking as well as associated cardiovascular a nd cerebrovascular conditions were greater in those patients with crit ical RVD compared to those without. These results indicate that RDS re mains technically feasible as renal blood flow and function decline. U nsuspected RVD possibly contributory to renal insufficiency exists in a significant number of primarily white patients 50 years of age or ol der beginning renal replacement therapy. These patients are generally smokers with a high frequency of associated extrarenal atherosclerosis . The addition of RVD as a separate category of disease causing ESRD w ould improve U.S. Renal Data System ESRD classification. RVD should be recognized as a cause of ESRD.