Risks for mortality and renal replacement therapy in atherosclerotic renovascular disease compared to other causes of chronic kidney disease

AIM: Patients with atherosclerotic renovascular disease (ARVD) have an increased risk for death and likelihood of initiating renal replacement therapy (RRT) compared to the general population. No data exist to describe prognosis in ARVD compared to other causes of chronic kidney disease (CKD). This study compares patient outcomes between ARVD and other causes of CKD.

METHODS: Patients were selected from two prospective observational cohort studies of outcome in ARVD and CKD. Multivariate Cox regression was used to compare risk for RRT and death (both prior to and following initiation of RRT) between patients with ARVD and other causes of CKD.

RESULTS: Of 1472 patients (563 [38%] ARVD, 909 [62%] non-ARVD), 242 [16%] progressed to RRT and 640 [44%] died over a median follow-up period of 4.1 [2.4-5.6] years. Patients with ARVD had an increased risk for death (HR 1.5 [1.2-1.8], p<0.001) but not for RRT (HR 1.0 [0.7-1.4], p=0.9). The largest increase in risk for death was observed relative to renal limited diseases e.g. pyelonephritis (HR 2.4 [1.3-4.5], p=0.004) and interstitial/infiltrative disease (HR 2.2 [1.3-4.5], p=0.02). No difference in risk for death existed between ARVD and diabetic nephropathy (HR 1.0 [0.8-1.3], p=0.8). Following initiation of RRT, patients with ARVD had a significantly increased risk for death compared to patients without ARVD (HR 3.3 [2.2-5.0], p<0.001).

CONCLUSIONS: Patients with ARVD as a cause of CKD have an increased risk for death both prior to and following initiation of RRT. Further work should seek to identify modifiable risk factors relevant to prognosis.