Original Investigations: Pathogenesis and Treatment of Kidney Disease and HypertensionA prospective study of the determinants of renal functional outcome and mortality in atherosclerotic renovascular disease
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Patient population
Patients attending the Renal Department at Hope Hospital (Salford, UK) who had undergone digital subtraction angiography (DSA) from 1995 to 1999 that showed evidence of ARVD were included on the study. Excluded patients were those not subsequently followed up by this renal service and, with the exception of patients with diabetes, with evidence of another primary condition affecting the kidneys (eg, glomerulonephritis).
Clinical data collection and end points
Data collection was prospective, which formed the basis of this
Clinical features of all study patients
From 1995 to 1999, ARVD was diagnosed by DSA in 98 patients who were subsequently followed up by the renal services at Hope Hospital. There were 50 men (51%) and 48 women. Age at diagnosis was 68.7 ± 8.3 years, and follow-up was 27.7 ± 18.7 months. Baseline CrCl was 35.5 ± 20.7 mL/min, and ΔCrCl was −2.8 ± 11.0 mL/min/y. Baseline systolic and diastolic blood pressures were 167.8 ± 30.4 and 87.6 ± 16.2 mm Hg, respectively. Baseline proteinuria was 0.9 ± 1.4 g/24 h. Sixty-seven patients had
Discussion
This is one of only a few prospective observational epidemiological studies investigating outcome in ARVD. We confirm the high mortality of patients with ARVD (35.7%), with death mainly of cardiovascular origin. Dialysis need (10.2%) was relatively low. The revascularization rate (11.2%) also was low, due to local policy derived from the noticeable absence of prospective randomized trials (which might show a conclusive benefit of renal revascularization to patient survival or renal functional
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Address reprint requests to Philip A. Kalra, MD, Department of Renal Medicine, Hope Hospital, Stott Lane, Salford M6 8HD, UK. E-mail: [email protected]
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