UNSUSPECTED RENAL-ARTERY STENOSIS IN 418 PATIENTS WITH PERIPHERAL-VASCULAR-DISEASES

The aim of the study was to evaluate the prevalence of renal artery st enosis (RAS) in patients with peripheral atherosclerotic arterial dise ase and the clinical implications of this association. Patients and Me thods: Between November 1993 and April 1995 we studied prospectively t he prevalence of RAS in 418 consecutive patients undergoing angiograph y for peripheral vascular disease. We obtained information about the d emographic data, the prevalence of cardiovascular risk factors (hypert ension, diabetes, smoking, hyperlipidemia and left ventricular hypertr ophy), the serum creatinine level, the severity of vascular disease on the basis of angiographic findings (categories I to III) and the exis tence of another cardiovascular pathology (ischaemic heart disease and cerebrovascular disease). For statistical analysis patients were divi ded in two groups according to the presence or absence of RAS and the patients without RAS Formed the control group. Results: RAS was detect ed in 114 patients (27%); in 30 of these (26%) it was bilateral and in 84 (74%) unilateral. The patients with RAS were older (72 +/- 10 vs 6 5 +/- 12 years, p < 0,001) had a higher prevalence of hypertension [59 % vs 36%, odds ratio OR] 2.5, 95 percent confidence interval [CI 1.6 t o 3.9, p < 0.001], a higher prevalence of severe arterial lesions -cat egory III- (66% vs 38%, OR 3.1, CI 2.01 to 4, p < 0.001) and a higher mean serum creatinine level (1.44 +/- 0.5 vs 1.21 +/- 0.3 mg/dl, p < 0 .001). No differences were found in the prevalence of hyperlipidemia, diabetes or smoking. Patients with RAS had a greater prevalence of isc haemic heart disease (26% vs 13%, OR 2.4, CI 1.4 to 4.1, p < 0.01) and left ventricular hypertrophy (25% vs 13%, OR 2.1, CI 1.2 to 3.6, p < 0.05). Using stepwise logistic regression analysis, the risk factors f or RAS were age, presence of hypertension, severity of peripheral vasc ular disease and the existence oi ischaemic heart disease. Conclusions : There is an important prevalence of unknown RAS in patients with per ipheral vascular disease. There is a direct relationship between the p resence of RAS and age, hypertension, severity of peripheral vascular disease, renal function and ischaemic heart disease. Arteriography, as part of the routine evaluation for patients with atherosclerotic arte rial disease have to include the study of renal arteries.