NDT Advance Access originally published online on May 3, 2005
Nephrology Dialysis Transplantation 2005 20(8):1604-1609; doi:10.1093/ndt/gfh865
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Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition
1 Unità Operativa Nefrologia e Dialisi, Policlinico Monteluce and 2 Istituto Radiologia Università di Perugia, Italy
Correspondence and offprint requests to: Attilio Losito, via dei Mille 5, San Mariano, 06070 Perugia, Italy. Email: atlosito{at}tin.it
Background. Patients with atherosclerotic renovascular disease (ARVD) are almost invariably treated by revascularization. However, the long-term outcomes of this approach on survival and progression to renal failure have not been investigated and have not been compared with that of a purely medical treatment. The aim of this observational study was to investigate factors affecting long-term (over 5 years) outcome, survival and renal function of patients with ARVD treated invasively or medically.
Methods. ARVD was demonstrated angiographically in 195 patients who were consecutively enrolled into a follow-up study. Patient age was 65.6±11.2 years, serum creatinine was 1.74±1.22 mg/dl and renal artery lumen narrowing was 73.5±17.5%. A revascularization was performed in 136 patients, whereas 54 subjects having comparable characteristics were maintained on a medical treatment throughout the study; five patients were lost during follow-up.
Results. The main follow-up was 54.4±40.4 months. The assessment of cardiovascular survival and renal survival at the end of follow-up revealed 46 cardiovascular deaths, 20 patients with end-stage renal disease (ESRD) and 41 patients with an increase in serum creatinine of over one-third. The multivariate analysis showed that renal revascularization did not affect mortality or renal survival compared with medical treatment. Revascularization produced slightly lower increases in serum creatinine and a better control of blood pressure. A longer survival was associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) (P = 0.002) in both revascularized and medically treated patients. The only significant predictor of ESRD was an abnormal baseline serum creatinine.
Conclusions. On long-term follow-up, ARVD was associated with a poor prognosis due to a high cardiovascular mortality and a high rate of ESRD. In our non-randomized study, revascularization was not a major advantage over medical treatment in terms of mortality or renal survival. The use of ACEIs was associated with improved survival.
Keywords: angiotensin-converting enzyme inhibitors; end-stage renal failure; renovascular disease; revascularization; survival
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