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Kim YE, Lee M, Lee YH, Kang ES, Cha BS, Lee BW. Proteinuria as a significant predictive factor for the progression of carotid artery atherosclerosis in non-albuminuric type 2 diabetes. Diabetes Res Clin Pract 2021; 181:109082. [PMID: 34627943 DOI: 10.1016/j.diabres.2021.109082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to evaluate the clinical significance of urine protein to creatinine ratio (uPCR) in relation to the cardiovascular risk associated with carotid artery intima-media thickness (cIMT) progression in subjects with type 2 diabetes (T2D) and normoalbuminuria. METHODS In this retrospective longitudinal study on T2D, we recruited 927 participants with normoalbuminuria (urine albumin to creatinine ratio [uACR] < 30 mg/g) whose cIMT was measured at baseline and after at least 1 year, and whose initial uPCR and uACR data were available. RESULTS Higher initial uPCR was positively correlated with a greater increment in maximal cIMT (β = 0.074, p = 0.028), and this correlation was significant even after adjusting for multiple confounding factors (β = 0.074, p = 0.046). High baseline uPCR was an independent predictive factor for the increased risk of maximal cIMT progression in a simple logistic regression model (OR, 1.41; 95% CI, [1.08-1.86]; p = 0.013). Even after adjusting for several confounding variables, higher uPCR was significantly associated with a higher risk of cIMT progression (OR, 1.48; 95% CI, [1.08-2.03]; p = 0.014). CONCLUSIONS These results suggest that high uPCR may be a useful predictive marker for the progression of carotid artery atherosclerosis, even in subjects with T2D and without albuminuria.
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Affiliation(s)
- Young-Eun Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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2
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Vemireddy LP, Ying GW, Aqeel A, Baig S, Buddharaju V. Is the Renal Resistive Index a Marker for Revascularization in Atherosclerotic Renal Artery Stenosis? Cureus 2021; 13:e14755. [PMID: 34094725 PMCID: PMC8169008 DOI: 10.7759/cureus.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Renal artery stenosis (RAS) is one of the major causes of resistant/malignant hypertension. It can be described as atherosclerotic or non-atherosclerotic. Atherosclerotic RAS comprises almost 90% of all RAS cases and is a prevalent disease of the elderly. Multiple risk factors contribute to atherosclerosis development, which leads to the release of renin and aldosterone, causing resistant/malignant hypertension. Early recognition is prudent but challenging as there are no early clinical signs. We believe that renal resistive index with supportive clinical, laboratory, and imaging modalities can help select revascularization patients.
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Affiliation(s)
- Lalitha Padmanabha Vemireddy
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program, Northwestern McHenry Hospital, Chicago, USA
| | - Grace W Ying
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program, Northwestern McHenry Hospital, Chicago, USA
| | - Ammar Aqeel
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program, Northwestern McHenry Hospital, Chicago, USA
| | - Shaji Baig
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Venkata Buddharaju
- Nephrology, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
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3
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Wang L, Liu B, Yan J, Wang Y, Wang W, Wang W, Chang H, Wang H, Wang C, Li Z, Li Y. Interventional Therapy for Transplant Renal Artery Stenosis Is Safe and Effective in Preserving Allograft Function and Improving Hypertension. Vasc Endovascular Surg 2016; 51:4-11. [PMID: 28100159 DOI: 10.1177/1538574416682157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To evaluate the outcomes of percutaneous intervention (PI) for transplant renal artery stenosis (TRAS). Materials and Methods: Doppler ultrasonography was used as the screening tool, and angiography was the diagnostic method for TRAS. The indications for PI were (1) a reduction in lumen diameter of >50% or (2) a mean pressure gradient of >15 mm Hg. Technical success was assessed immediately after the procedure. The short-term results of stenosis were evaluated by serum creatinine (Scr) levels and blood pressure (BP). The long-term results were assessed by graft survival and renal function. Results: From October 2009 to July 2015, a total of 660 patients had kidney transplantation and 22 cases underwent PI. The technical success was 100%. The mean Scr level preintervention was 321.6 ± 167.2 (range, 171.3-862.0) μmol/L, and it decreased to 145.3 ± 44.7 (range, 74.3-260.8) μmol/L 1 month postintervention ( P < .001). Blood pressure was also improved at 1 month postintervention, as assessed by systolic (157.0 ± 13.0 vs 131.0 ± 11.0 mm Hg, P < .001), diastolic (95.0 ± 5.0 vs 77.0 ± 9.0 mm Hg, P < .001), and mean arterial pressure (116.0 ± 7.0 vs 95.0 ± 9.0 mm Hg, P < .001). The patency rate was 100%, 91.7%, and 85.7% at 1, 3, and 12 months, respectively. The secondary patency rate was 100%. Graft survival was 100% during follow-up. There was no significant deterioration in graft function or BP ( P > .05) postintervention when compared to posttransplantation. Conclusions: Percutaneous intervention for TRAS is safe and results in significant improvement both in allograft function and in BP.
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Affiliation(s)
- Lili Wang
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Bin Liu
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Jieke Yan
- Department of Kidney Transplantation, the Second Hospital of Shandong University, Jinan, China
| | - Yongzheng Wang
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Wujie Wang
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Wei Wang
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Haiyang Chang
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Hongwei Wang
- Department of Kidney Transplantation, the Second Hospital of Shandong University, Jinan, China
| | - Changjun Wang
- Department of Radiology, The Jiyang People’s Hospital, Jinan, Shandong, China
| | - Zheng Li
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
| | - Yuliang Li
- Department of Interventional Medicine, the Second Hospital of Shandong University, Jinan, China
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4
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Trani C, Porto I, Tommasino A, Giammarinaro M, Burzotta F, Niccoli G, Leone AM, Coroleu SF, Cautilli G, Mazzari MA, Schiavoni G, Crea F. Baseline inflammatory status and long-term changes in renal function after percutaneous renal artery stenting: A prospective study. Int J Cardiol 2013; 167:1006-11. [DOI: 10.1016/j.ijcard.2012.03.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
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5
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Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease? Public Health 2013; 127:435-41. [DOI: 10.1016/j.puhe.2012.12.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/02/2012] [Accepted: 12/21/2012] [Indexed: 11/21/2022]
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6
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Pu LJ, Shen Y, Zhang RY, Zhang Q, Lu L, Ding FH, Hu J, Yang ZK, Shen WF. Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention. J Zhejiang Univ Sci B 2012; 13:631-7. [PMID: 22843183 DOI: 10.1631/jzus.b1201003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. METHODS Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. RESULTS Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1-P)=exp(-2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. CONCLUSIONS The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.
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Affiliation(s)
- Li-jin Pu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Abstract
PURPOSE OF REVIEW To discuss the beneficial effects of statin treatment in patients with peripheral arterial disease (PAD), abdominal aortic aneurysms (AAAs), atherosclerotic renal artery stenosis (ARAS) and carotid artery disease. RECENT FINDINGS Evidence suggests that statins may reduce the progression (or even reverse the development) of carotid artery stenosis and AAAs. Statins also improve several indices (e.g. serum creatinine) and preserve renal function in ARAS. In patients with PAD, statins are associated with improved claudication distance and time, reduced cardiovascular events, and improved graft patency rates should these patients undergo surgery. Finally, statins are associated with improved perioperative and long-term morbidity and mortality rates in all vascular patients whether they undergo surgery or endovascular procedures. SUMMARY Routine statin treatment should be implemented for all vascular patients to ensure a reduced progression of their disease, as well as a reduction in cardiovascular events.
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8
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Liang F, Hu DY, Wu MY, Li TC, Tang CZ, Wang JY, Lu CL. The incidence of renal artery stenosis in the patients referred for coronary artery bypass grafting. Indian J Nephrol 2012; 22:13-7. [PMID: 22279337 PMCID: PMC3263057 DOI: 10.4103/0971-4065.91181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Multivessel coronary disease or peripheral arterial disease is the clinical clue to diagnosis of renal artery stenosis (RAS). RAS is considered equivalent to coronary artery disease in terms of cardiovascular risk. In this study, we evaluated the incidence of RAS in the patients who were proposed to undergo coronary artery bypass grafting (CABG). Diagnostic evaluations of coronary arteriography and renal artery angiography were performed during the same procedure; the patients who were proposed for CABG in terms of CAD anatomy and clinical manifestation were enrolled. RAS was evaluated and a diameter stenosis of ≥50% was considered as significant RAS; significant RAS patients were divided into five groups. The five groups of RAS were as follows: (1) unilateral RAS ≥50–70%, (2) unilateral RAS ≥70%, (3) bilateral RAS ≥50–70%, (4) one-renal-artery stenosis ≥50–70%, contralateral RAS ≥70%, and (5) bilateral renal artery stenosis ≥70%. A total of 151 patients were enrolled, and RAS (≥50% stenosis in either or both renal arteries) was identified in 47.02% (71/151) patients. Unilateral RAS ≥50–70% was identified in 16.6% (25/151) patients, unilateral RAS ≥70% in 4.6% (7/151) patients, bilateral RAS ≥50–70% in 7.9% (12/151) patients, one-renal-artery stenosis ≥50–70% and contralateral RAS ≥70% in 7.9% (12/151) patients, and bilateral RAS ≥70% was in 9.9%(15/151) patients. The incidence of RAS was 29.03% (18/62) in patients aged ≤60 years, 60% (36/60) in patients aged >60 and ≤70 years, and 58.62% (17/29) in patients aged >70 years. The incidence of RAS was significantly higher in patients aged >60 - ≤70, and >70 years than patients aged ≤60 years (P = 0.001 and P = 0.007, respectively). There was a trend that the incidence of RAS in patients with hypertension [HTN, 50.40% (64/127)] was higher than those without HTN (29.17%, 7/24), with P = 0.056. The incidence of RAS was 47.02% in patients who were proposed for CABG; bilateral RAS of ≥70% was 9.9%. Older age and HTN were associated with RAS in patients who were referred for CABG. This study indicates that the incidence of RAS was high in the patients referred for CABG, and the renal function should be taken care of.
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Affiliation(s)
- F Liang
- Department of Cardiology, Daxing Hospital, Capital University of Medical Science, Beijing, People's Republic of China
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9
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Abstract
PURPOSE OF REVIEW To provide an update of the literature describing the link between lipoprotein a and vascular disease. RECENT FINDINGS There is evidence that elevated plasma lipoprotein a levels are associated with coronary heart disease, stroke and other manifestations of atherosclerosis. Several mechanisms may be implicated, including proinflammatory actions and impaired fibrinolysis. SUMMARY Lipoprotein a potentially represents a useful tool for risk stratification in the primary and secondary prevention setting. However, there are still unresolved methodological issues regarding the measurement of lipoprotein a levels. Targeting lipoprotein a in order to reduce vascular risk is hampered by the lack of well tolerated and effective pharmacological interventions. Moreover, it has not yet been established whether such a reduction will result in fewer vascular events. The risk attributed to lipoprotein a may be reduced by aggressively tackling other vascular risk factors, such as low-density lipoprotein cholesterol.
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10
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Seratnahaei A, Shah A, Bodiwala K, Mukherjee D. Management of transplant renal artery stenosis. Angiology 2010; 62:219-24. [PMID: 20682611 DOI: 10.1177/0003319710377076] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
End-stage renal disease (ESRD) was universally fatal until dialysis (peritoneal and hemodialysis) and renal transplantation were introduced. However, there are multiple complications associated with transplantation including transplant renal artery stenosis (TRAS). Transplant renal artery stenosis is an important cause of premature renal failure, uncontrolled hypertension, and allograft loss. There are 3 treatment modalities available for TRAS: optimal medical therapy alone, percutaneous intervention, and surgical revascularization both with optimal medical therapy. Percutaneous transluminal angioplasty (PTA) has now become the initial treatment of choice for TRAS. However, there are conflicting data regarding the efficacy of PTA, with growing evidence showing lack of significant benefit in blood pressure (BP) or renal function in patients undergoing PTA versus medical management. However, there have been no randomized control studies that have established the superiority of either method. We review the existing data and analyze management of TRAS as reported in multiple case series including findings from our center.
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Affiliation(s)
- Arash Seratnahaei
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
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11
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Cianci R, Martina P, Borghesi F, di Donato D, Polidori L, Lai S, Ascoli G, de Francesco I, Zaccaria A, Gigante A, Barbano B. Revascularization Versus Medical Therapy for Renal Artery Stenosis: Antihypertensive Drugs and Renal Outcome. Angiology 2010; 62:92-9. [DOI: 10.1177/0003319710371615] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rosario Cianci
- Department of Nephrology, Sapienza, University of Rome,
Italy,
| | - Paola Martina
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | | | | | - Lelio Polidori
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | - Silvia Lai
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | - Giada Ascoli
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | | | - Alvaro Zaccaria
- Department of Vascular and Endovascular Surgery, San
Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - Antonietta Gigante
- Department of Vascular and Endovascular Surgery, San
Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - Biagio Barbano
- Department of Nephrology, Sapienza, University of Rome,
Italy
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12
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Stepien M, Banach M, Mikhailidis DP, Gluba A, Kjeldsen SE, Rysz J. Role and significance of statins in the treatment of hypertensive patients. Curr Med Res Opin 2009; 25:1995-2005. [PMID: 19555312 DOI: 10.1185/03007990903098081] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Statins are the first-line drug therapy in the treatment of hypercholesterolemia. The beneficial clinical impact of statins on the cardiovascular system results not only from their lipid-lowering action but also from other effects. Recently, it has been suggested that statins can reduce blood pressure, especially in hypertensive patients. AIM The role of the hypotensive action of statins and other mechanisms which reduce cardiovascular risk in hypertensive patients are discussed in this review. METHODS Electronic databases searched were [MEDLINE (1966 - February 2009), EMBASE and SCOPUS (1965 - February 2009), DARE (1966 -- February 2009)]. Additionally, abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. The main data search terms were: blood pressure, hypertension, hypercholesterolemia and statins. FINDINGS At present, it is difficult to unequivocally assess the impact of statins on blood pressure. However, according to most authors, the impact of statins on the decrease in BP is slight, but significant, especially among patients with hypertension.
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Affiliation(s)
- Mariusz Stepien
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland
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13
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Tziomalos K, Ganotakis ES, Gazi IF, Nair DR, Mikhailidis DP. Kidney function and estimated vascular risk in patients with primary dyslipidemia. Open Cardiovasc Med J 2009; 3:57-68. [PMID: 19572030 PMCID: PMC2703830 DOI: 10.2174/1874192400903010057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 05/22/2009] [Accepted: 05/25/2009] [Indexed: 01/30/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is associated with increased vascular risk. Some studies suggested that considering markers of CKD might improve the predictive accuracy of the Framingham risk equation. Aim: To evaluate the links between kidney function and risk stratification in patients with primary dyslipidemia. Methods: Dyslipidemic patients (n = 156; 83 men) who were non-smokers, did not have diabetes mellitus or evident vascular disease and were not on lipid-lowering or antihypertensive agents were recruited. Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault equation. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We estimated vascular risk using the Framingham equation. Results: In both men and women, there was a significant negative correlation between estimated Framingham risk and both eGFR and CrCl (p < 0.001 for all correlations). When men were divided according to creatinine tertiles, there were no significant differences in any parameter between groups. When men were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined (p<0.001 for all trends). When women were divided according to creatinine tertiles, all estimated Framingham risks except for stroke significantly increased as creatinine levels increased. When women were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined. Conclusions: Estimated vascular risk increases as renal function declines. The possibility that incorporating kidney function in the Framingham equation will improve risk stratification requires further evaluation.
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Affiliation(s)
- Konstantinos Tziomalos
- Department of Clinical Biochemistry (Vascular Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Karagiannis A, Tziomalos K, Anagnostis P, Gossios T, Athyros VG. Atherosclerotic renal artery stenosis: medical therapy alone or in combination with revascularization? Angiology 2009; 60:397-402. [PMID: 19505885 DOI: 10.1177/0003319709334262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Ozkan U. Vascular risk factors in atherosclerotic renal artery stenosis. Eur J Radiol 2008. [DOI: 10.1016/j.ejrad.2008.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Paraskevas KI. What is the role of emerging vascular risk factors in atherosclerotic renal artery stenosis? Eur J Radiol 2008; 68:180; author reply 180-1. [DOI: 10.1016/j.ejrad.2008.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Cianci R, Gigante A, Polidori L, Di Donato D, Martina P, Barbano B, Renzulli R, Zaccaria A, Fuiano G. In-Stent Restenosis of the Renal Artery in a Single Kidney Patient: The Role of ACEI in the Therapeutic Choice. Angiology 2008; 60:496-503. [DOI: 10.1177/0003319708322172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal artery stenosis (RAS) caused by atherosclerotic changes of the renal arteries has become a concern as a cause of end-stage renal failure. Percutaneous balloon angioplasty with or without endovascular stenting is an increasingly accepted procedure at the expense of classical approaches such as aortorenal bypass and other types of surgery. Renal percutaneous transluminal angioplasty and stenting (RPTAS) represent the first therapeutic choice; however, there is doubt regarding the satisfactory long-term outcome for primary RPTAS. Currently, there is no clear evidence whether or not RPTAS prevents further progressive renal function decline because comparisons between interventional randomized studies and medical therapy are still lacking. Despite the fact that the use of angiotensin-converting enzyme inhibitors (ACEIs) may be a potential cause of acute renal failure, clinical data suggest that ACEI therapy is associated with better survival in patient with RAS. In our case, the use of ACEIs has been fundamental for the indirect evaluation of restenosis degree and RPTAS.
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Affiliation(s)
- Rosario Cianci
- Department of Nephrology, University of Rome “La Sapienza,”, Italy
| | | | - Lelio Polidori
- Department of Nephrology, University of Rome “La Sapienza,”, Italy
| | | | - Paola Martina
- Department of Nephrology, University of Rome “La Sapienza,”, Italy
| | - Biagio Barbano
- Department of Nephrology, University of Rome “La Sapienza,”, Italy
| | - Roberta Renzulli
- Department of Nephrology, University of Rome “La Sapienza,”, Italy
| | - Alvaro Zaccaria
- Vascular Surgery, S. Pietro Fatebenefratelli Hospital Rome, Italy
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18
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Paraskevas KI, Bessias N, Papas TT, Gekas CD, Andrikopoulos V, Mikhailidis DP. Do Different Vascular Risk Factors Affect All Arteries Equally? Angiology 2008; 59:397-401. [DOI: 10.1177/0003319708318383] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Established vascular risk factors (ie, smoking, hypertension, diabetes mellitus, and dyslipidemia) play an important role in the development of vascular disease. Emerging evidence suggests that some of these risk factors may have a more intense effect on specific arterial beds, a finding that holds implications for a prognostic role for certain types of vascular disease.
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Affiliation(s)
| | - Nikolaos Bessias
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
| | | | | | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention clinics), Royal Free Hospital campus, University College London, United Kingdom,
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19
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Paraskevas KI, Stathopoulos V, Mikhailidis DP, Perrea D. Smoking, Abdominal Aortic Aneurysms, and Ischemic Heart Disease: Is There a Link? Angiology 2008; 59:664-6. [DOI: 10.1177/0003319708322392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kosmas I. Paraskevas
- Department of Experimental Surgery and Surgical Research “N. S. Christeas," Medical School, National and Kapodistrian University of Athens, Department of Vascular Surgery, Red Cross Hospital
| | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London, United Kingdom,
| | - Despina Perrea
- Department of Experimental Surgery and Surgical Research “N. S. Christeas," Medical School, National and Kapodistrian University of Athens
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