肾外动脉粥样硬化疾病会削弱肾血管性高血压患者的肾脏恢复能力。
Extrarenal atherosclerotic disease blunts renal recovery in patients with renovascular hypertension.
作者信息
Khangura Kirandeep K, Eirin Alfonso, Kane Garvan C, Misra Sanjay, Textor Stephen C, Lerman Amir, Lerman Lilach O
机构信息
aDivisions of Nephrology and Hypertension bCardiovascular Diseases cVascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
J Hypertens. 2014 Jun;32(6):1300-6. doi: 10.1097/HJH.0000000000000160.
BACKGROUND
Atherosclerotic renovascular disease (ARVD) is associated with high rates of coronary events and predicts mortality among patients with coronary artery disease (CAD). However, the impact of coronary atherosclerosis on renal outcomes after revascularization of ARVD is unclear. We hypothesized that CAD negatively impacts renal functional outcomes among patients with ARVD undergoing renal artery revascularization.
METHODS
Patients with ARVD who underwent echocardiography at Mayo Clinic, Rochester, Minnesota, USA between 2004 and 2012 were identified retrospectively and included if they had ejection fraction more than 50%. Renal and overall outcomes were compared among atherosclerotic renovascular disease patients with coronary artery disease (ARVD-C, n = 75) and without coronary artery disease (ARVD, n = 56), within 1 year from initial revascularization and included blood pressure control, renal function, and incident cardiovascular/cerebrovascular events.
RESULTS
Degree of renal artery stenosis was similar in both groups. ARVD-C had higher prevalence of diabetes, peripheral artery disease (PAD), and cerebrovascular disease, and lower baseline renal function. Risk of developing end-stage renal disease was higher in ARVD-C (11 vs. 2%, P = 0.05). Despite better control of blood pressure and cholesterol levels, renal function postrevascularization worsened in 15% of ARVD-C compared with 2% of ARVD (P = 0.01). Differences in clinical outcomes remained statistically significant after adjustment for covariables, including sex, baseline blood pressure, renal function, underlying diabetes, cholesterol levels, and medications. Similar differences in clinical outcomes were also associated with PAD and cerebrovascular disease.
CONCLUSION
CAD in patients with ARVD is a predictor of worse outcomes after renal revascularization, likely reflecting diffuse atherosclerotic disease. Further studies are needed to develop strategies to manage patients with vascular comorbidities and improve their outcomes.
背景
动脉粥样硬化性肾血管疾病（ARVD）与冠心病事件的高发生率相关，并可预测冠心病（CAD）患者的死亡率。然而，冠状动脉粥样硬化对ARVD血管重建术后肾脏结局的影响尚不清楚。我们假设CAD会对接受肾动脉血管重建术的ARVD患者的肾功能结局产生负面影响。
方法
回顾性确定2004年至2012年在美国明尼苏达州罗切斯特市梅奥诊所接受超声心动图检查的ARVD患者，若其射血分数超过50%则纳入研究。在首次血管重建术后1年内，比较患有冠心病的动脉粥样硬化性肾血管疾病患者（ARVD-C，n = 75）和无冠心病的动脉粥样硬化性肾血管疾病患者（ARVD，n = 56）的肾脏和总体结局，包括血压控制、肾功能以及心血管/脑血管事件的发生情况。
结果
两组肾动脉狭窄程度相似。ARVD-C组糖尿病、外周动脉疾病（PAD）和脑血管疾病的患病率更高，基线肾功能更低。ARVD-C组发生终末期肾病的风险更高（11%对2%，P = 0.05）。尽管血压和胆固醇水平控制得更好，但ARVD-C组中有15%的患者血管重建术后肾功能恶化，而ARVD组为2%（P = 0.01）。在对包括性别、基线血压、肾功能、基础糖尿病、胆固醇水平和药物在内的协变量进行调整后，临床结局的差异仍具有统计学意义。PAD和脑血管疾病也与临床结局的类似差异相关。
结论
ARVD患者的CAD是肾血管重建术后预后较差的预测因素，可能反映了弥漫性动脉粥样硬化疾病。需要进一步研究以制定管理血管合并症患者并改善其结局的策略。
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