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Cited by 195Renal and Vascular PathologiesPeripheral Artery Disease ManagementCerebrovascular and Carotid Artery Diseases

The DOI matches its Crossref record; 28 of the 28 references it cites were found in a registry or an index.

High-Risk Clinical Presentations in Atherosclerotic Renovascular Disease: Prognosis and Response to Renal Artery Revascularization

Ritchie, James, Green, Darren, Chrysochou, Constantina, Chalmers, Nicholas, Foley, Robert N., Kalra, Philip A.·2014·American Journal of Kidney Diseases
DOI 10.1053/j.ajkd.2013.07.020
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Abstract

Background Current trial data may not be directly applicable to patients with the highest risk presentations of atherosclerotic renovascular disease, including flash pulmonary edema, rapidly declining kidney function, and refractory hypertension. We consider the prognostic implications of these presentations and response to percutaneous revascularization.Study design Single-center prospective cohort study; retrospectively analyzed.Setting & participants 467 patients with renal artery stenosis ≥50%, managed according to clinical presentation and physician/patient preference.Predictors Presentation with flash pulmonary edema (n = 37 [7.8%]), refractory hypertension (n = 116 [24.3%]), or rapidly declining kidney function (n = 46 [9.7%]) compared to low-risk presentation with none of these phenotypes (n = 230 [49%]). Percutaneous revascularization (performed in 32% of flash pulmonary edema, 28% of rapidly declining kidney function, and 28% of refractory hypertension patients) compared to medical management.Outcomes Death, cardiovascular (CV) event, end-stage kidney disease.Results During a median follow-up of 3.8 (IQR, 1.8-5.8) years, 55% died, 33% had a CV event, and 18% reached end-stage kidney disease. In medically treated patients, flash pulmonary edema was associated with increased risk of death (HR, 2.2; 95% CI, 1.4-3.5; P < 0.001) and CV event (HR, 3.1; 95% CI, 1.7-5.5; P < 0.001), but not end-stage kidney disease, compared to the low-risk phenotype. No increased risk for any end point was observed in patients presenting with rapidly declining kidney function or refractory hypertension. Compared to medical treatment, revascularization was associated with reduced risk for death (HR, 0.4; 95% CI, 0.2-0.9; P = 0.01), but not CV event or end-stage kidney disease, in patients presenting with flash pulmonary edema. Revascularization was not associated significantly with reduced risk for any end point in rapidly declining kidney function or refractory hypertension. When these presentations were present in combination (n = 31), revascularization was associated with reduced risk for death (HR, 0.15; 95% CI, 0.02-0.9; P = 0.04) and CV event (HR, 0.23; 95% CI, 0.1-0.6; P = 0.02).Limitations Observational study; retrospective analysis; potential treatment bias.Conclusions This analysis supports guidelines citing flash pulmonary edema as an indication for renal artery revascularization in atherosclerotic renovascular disease. Patients presenting with a combination of rapidly declining kidney function and refractory hypertension also may benefit from revascularization and may represent a subgroup worthy of further investigation in more robust trials.

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Crossref · 10.1053/j.ajkd.2013.07.020

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Metadata

Authors
Ritchie, J., Green, D., Chrysochou, C., Chalmers, N., Foley, R. N., & Kalra, P. A.
Affiliations
  • Manchester Academic Health Science Centre (GB)
  • Manchester Royal Infirmary (GB)
Corresponding author
Kalra, Philip A.
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
2014-02
Volume
63
Issue
2
Pages
186-197
ISSN
0272-6386 (ISSN-L)
DOI
10.1053/j.ajkd.2013.07.020
OpenAlex
W1984139402
Cited by
195
References
28
Citations by year
2026: 7 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 15 · 2021: 17 · 2020: 14 · 2019: 17 · 2018: 11 · 2017: 22 · 2016: 20 · 2015: 18 · 2014: 20
FWCI
15.75
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Renal and Vascular Pathologies
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords
atherosclerotic renovascular disease, renal artery stenosis, flash pulmonary edema, resistant hypertension, prognosis, end-stage renal disease, cardiovascular events, mortality, renal function decline
MeSH terms
Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Kidney Failure, Chronic, Male, Middle Aged, Prognosis, Prospective Studies, Renal Artery Obstruction, Retrospective Studies, Cohort Studies, Atherectomy, Atherosclerosis

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