Journal Article

Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition

Attilio Losito, Rosa Errico, Paola Santirosi, Tommaso Lupattelli, Giovanni Battista Scalera and Luciano Lupattelli

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 20, issue 8, pages 1604-1609
Published in print August 2005 | ISSN: 0931-0509
Published online May 2005 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfh865
Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition

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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

Journal Article.  3388 words.  Illustrated.

Subjects: Nephrology

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