FACTORS ASSOCIATED WITH LONG-TERM CARDIOVASCULAR SURVIVAL IN ATHEROSCLEROTIC ISCHEMIC KIDNEY DISEASE

Objective. To find clinical predictors of long-term cardiovascular survival in patients with ischemic kidney  disease (IKD) caused by atherosclerotic renal arteries lesions.

Design and methods. In 1999–2012, 185 patients (118 males; aged 35–79 years) with the diagnosed significant atherosclerotic lesions of renal arteries (stenosis ≥ 50 %) were included in an open, single-center observation prospective study. Among them 123 subjects underwent renal revascularization (RR): open surgery in 61 cases, percutaneous angioplasty of renal arteries and stent implantation — in 62 patients. The mean follow-up was 33 months (95 % confidence interval 29–37 months). The estimated outcomes included hypertension dynamics, renal function and cardiovascular mortality. KaplanMeyer  curves and Cox proportional hazards regression model were used for survival analysis and associated factors assessment.

 Results. Cumulative cardiovascular survival in IKD patients after renal revascularization was significantly higher. Regression analysis showed that the independent predictors of long-term cardiovascular mortality included renal revascularization, cerebrovascular disease and lower limbs ischemia. Relative risks of cardiovascular death were 0,25 in case of renal revascularization; 4,0 and 3,7 in the presence of cerebrovascular disease and lower limb ischemia, respectively. Independent predictors of long-term cardiovascular mortality after RR were lack of hypertension improvement (OR 8,7); post-surgery estimated glomerular filtration rate ≤ 45 ml/min/1,73 m  (OR 5,6); baseline proteinuria ≥ 1 g/day (OR 8,7); and peripheral artery disease with the lower limb ischemia (OR 46).

 Conclusion. Renal revascularization is associated with the higher long-term cardiovascular survival. An improvement of cardiovascular prognosis in IKD patients after surgery should be expected when antihypertensive and renoprotective efficacy of RR is achieved and concomitant lower limb ischemia is cured.  

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