Prevalence and prediction of renal artery stenosis in patients with coronary and supraaortic artery atherosclerotic disease

Background. Renal atherosclerosis is associated with increased cardiovascular mortality. This study aimed to determine the prevalence and predictors of renal artery stenosis (RAS) in patients with coronary artery disease (CAD) and supraaortic arteries (SA) stenosis. Methods. Renal angiography was performed in 1193 (807 men) consecutive patients referred for coronary or SA angiography. Group I included 296 (136 men, 60.1 ± 9.5 years) patients with no significant (<50%) lesion in coronary arteries or SA; group II included 706 (526 men, 62.2 ± 9.7 years) patients with stenosis ≥50% within single arterial territory (coronary arteries or SA) and group III included 191 (145 men, 64.9 ± 8.5 years) patients with stenosis ≥50% in both territories. Results. Some RAS was found in 55 (18.6%) patients in group I, 250 (35.4%) patients in group II and 115 (60.2%) patients in group III (P < 0.001). The proportion of patients with RAS ≥50% in groups I, II and III was 3.3, 6.2 and 18.3%, respectively (P < 0.001). RAS prevalence increased with the number of stenosed coronary arteries (38.4% in 1-vessel, 42.1% in 2-vessel, 48.5% in 3-vessel CAD, P < 0.001). Independent predictors of RAS ≥50% identified by logistic regression analysis were SA stenosis [relative risk (RR) = 3.28, P < 0.001], 2-3-vessel-CAD (RR = 2.04, P = 0.002), creatinine level ≥1.07 mg/dl (RR = 2.95, P < 0.001), hypertension (RR = 2.97, P = 0.012) and body mass index <25 kg/m2 (RR = 1.42, P = 0.169). A calculated score for RAS ≥50% prediction (based on the regression model) was reliable (coefficient of determination, R = 0.978) and showed a sensitivity of 77.5% and a specificity of 63.9%. Conclusions. RAS prevalence and severity increases with the number of arterial territories involved and CAD severity. The following independent predictors of RAS ≥50% were identified: SA involvement, 2-3-vessel-CAD, serum creatinine level and hypertension.