Original InvestigationPathogenesis and Treatment of Kidney DiseaseHigh-Risk Clinical Presentations in Atherosclerotic Renovascular Disease: Prognosis and Response to Renal Artery Revascularization
Section snippets
Description of Cohort and Inclusion Criteria
Since 1995, information about all patients referred to our tertiary renal center (catchment population, 1.55 million) diagnosed with ARVD (either by intra-arterial digital subtraction angiography or computed tomography/magnetic resonance angiography) has been entered into a prospectively populated database. Each patient record is updated annually by nephrology residents and contains details of imaging results, clinical presentation, comorbid conditions, CV events, prescribed medications, blood
Results
A total of 819 patient records were reviewed, with 109 excluded due to incomplete baseline data, 144 excluded due to renal artery stenosis <50%, and 99 excluded due to unilateral occlusion with stenosis <50% on the contralateral side. Data from 467 patients were analyzed, with a median follow-up of 3.8 (IQR, 1.8-5.8) years. Baseline demographics of excluded patients are presented in Table S2.
One or more high-risk presentation was exhibited by 237 (51%) patients, 58 (24%) of whom underwent
Discussion
To our knowledge, this cohort of 467 patients with an overall revascularization rate of 27%, comparable to that seen in Medicare claims data,3 includes the largest series of patients with flash pulmonary edema, and the only series of patients with flash pulmonary edema to include a medically treated comparator group. These data, representing more than 15 years of clinical practice, reflect the findings of the ASTRAL trial and other randomized trials in a real-life setting: for an unselected
Acknowledgements
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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