SURVIVAL IN RENAL VASCULAR-DISEASE

Renal artery stenosis (RAS) is a relatively uncommon but important pot entially reversible cause of renal failure. Little is known about the natural history of ischemic renal disease secondary to RAS. In previou s reports, these researchers examined the incidence and risk factors a ssociated with RAS. The study presented here investigates the long-ter m follow-up of these patients, specifically the effect of RAS on 4-yr, all-cause mortality in a group of 1235 patients undergoing diagnostic cardiac catheterization and abdominal aortography. A total of 1235 co nsecutive patients undergoing cardiac catheterization also underwent a n abdominal flush aortogram. Significant RAS was considered present if one or more renal artery had 50% or greater narrowing in luminal diam eter. Four-year unadjusted survival for patients with RAS was 65% comp ared with 86% for patients undergoing catheterization without signific ant RAS. Factors associated with decreased 4-yr survival included incr eased age, increased serum creatinine, presence of RAS. peripheral vas cular disease, congestive heart failure, diabetes, hypertension, and r educed ejection fraction. Using the Cox proportional hazards model, th e factors associated with decreased 4-yr survival were the presence of significant RAS, reduced ejection fraction, elevated serum creatinine , and symptoms of congestive heart failure. These observations indicat e that the presence of significant RAS is a strong independent predict or of 4-yr survival in this patient population.