Renal artery stenosis predicts adverse cardiovascular and renal outcome in patients with peripheral artery disease

Background Patients with symptomatic peripheral artery disease (PAD) are considered cardiovascular high-risk patients. Our aim was to investigate whether incidental renal artery stenosis (RAS) increases the risk for adverse cardiovascular and renal outcomes in these patients. Materials and methods We prospectively enrolled 487 consecutive patients admitted for revascularization of symptomatic PAD and performed a renal overview angiogram categorizing RAS as absent (0-29%), moderate (30-59%) and severe (>= 60%) respectively. Clinical follow-up was for median 15 months (IQR 12-22) for the occurrence of major adverse events [MAE: composite of death, myocardial infarction (MI), stroke, percutaneous coronary intervention, coronary bypass surgery, amputation and kidney failure]. Glomerular filtration rates (GFR) were obtained at 12 months to quantify the course of renal function. Results A severe RAS was found in 76 patients (15 center dot 6%). Overall MAE occurred in 121 patients (24 center dot 8%), the composite endpoint of MI, stroke, amputation and death occurred in 101 patients (20 center dot 7%). Patients with a severe RAS had a 1 center dot 87-fold increased adjusted risk for MAE (95% CI 1 center dot 12-3 center dot 12, P = 0 center dot 017), a 2 center dot 51-fold increased adjusted risk for occurrence of the composite endpoint of MI, stroke, amputation and death (95% CI 1 center dot 45-4 center dot 34, P = 0 center dot 001) and a 2 center dot 93-fold increased risk for death (95% CI 1 center dot 41-6 center dot 08, P = 0 center dot 004), compared to those of patients without RAS respectively. We observed a significant association between the decrease of GFR over the 12-month follow-up period and the severity of RAS by multivariable analysis (P = 0 center dot 044). Conclusion Severe RAS in patients with symptomatic PAD is an independent predictor of major adverse cardiovascular events, adverse renal outcome and mortality.