PROGRESSION OF RENAL-ARTERY STENOSIS IN PATIENTS UNDERGOING CARDIAC-CATHETERIZATION

Background Renal artery stenosis is potentially correctable by either revascularization surgery or percutaneous methods. However, appropriat e use of these techniques has been hampered by a lack of data on the n atural history of this disease. This study assesses the prevalence, ri sk factors for progression, and effect on renal function of angiograph ically demonstrated renal artery disease in patients undergoing cardia c catheterization. Methods The seventy of renal artery stenosis was qu antified in all patients who underwent abdominal aortography or port o f ct diagnostic cardiac catheterization study at Duke University Medic al Center between January 1989 and February 1996. Results There were 1 4,152 patients in the study (mean age 61 +/- 12 years, 62% male). Norm al renal arteries were identified in 12,543 (88.7%) patients, insignif icant disease (<50% stenosis) in 1 or more vessels in 726 patients (5. 1%), and significant stenosis in 883 patients (6.3%). Significant bila teral renal artery stenosis was present in 178 patients (1.3%). By mul tivariate logistic regression, elevated serum creatinine level, corona ry artery disease, peripheral vascular disease, hypertension, cerebrov ascular disease, older age, female sex, and family history of coronary artery disease were identified as independent predictors of sig signi ficant renal arterial disease. Disease progression was assessed in 118 9 patients. Mean time between cardiac catheterizations was 2.6 +/- 1.6 years. Significant disease progression occurred in 133 patients (11.1 %). Independent predictors of disease progression were Female sex, age , coronary artery disease at baseline, and time between baseline and f ollow-up. At follow-up, serum creatinine level was significantly highe r in patients who demonstrated greater than or equal to 75% stenosis i n 1 or more vessels (mean creatinine level 141 +/- 114 mu mol/L compar ed with those with insignificant disease (mean creatinine level 97 +/- 44 mu mol/L (P = .01). Conclusions Renal artery disease is frequently progressive in patients who undergo cardiac catheterization for inves tigation of coronary artery disease. Significant stenotic disease may develop over a short period despite evidence of normal renal arteries at prior catheterization.