Prevalence and risk factors for renal artery stenosis and chronic kidney disease in Japanese patients with peripheral arterial disease

• Published in: Hypertension research Vol. 33; no. 9; pp. 911 - 915
• Main Authors: Endo, Michiko, Kumakura, Hisao, Kanai, Hiroyoshi, Araki, Yoshihiro, Kasama, Shu, Sumino, Hiroyuki, Ichikawa, Shuichi, Kurabayashi, Masahiko
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2010
• Subjects: 692/499; 692/699/1585/104; 692/699/1585/1782; 692/699/75/593/1920; Age Factors; Aged; Aged, 80 and over; Albuminuria - diagnostic imaging; Albuminuria - epidemiology; Angiography; Asian Continental Ancestry Group - statistics & numerical data; Cholesterol, LDL - blood; chronic kidney disease; Comorbidity; Coronary Disease - diagnostic imaging; Coronary Disease - epidemiology; Coronary Disease - physiopathology; Diabetes Mellitus - epidemiology; Extremities - diagnostic imaging; Extremities - physiopathology; Female; Geriatrics/Gerontology; Glomerular Filtration Rate; Health Promotion and Disease Prevention; Humans; Hypertension - diagnostic imaging; Hypertension - epidemiology; Hypertension - physiopathology; Internal Medicine; Ischemia - diagnostic imaging; Ischemia - epidemiology; Male; Medicine; Medicine & Public Health; microalbuminuria; Middle Aged; Obstetrics/Perinatology/Midwifery; original-article; peripheral arterial disease; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - epidemiology; Prevalence; Public Health; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - epidemiology; Renal Artery Obstruction - etiology; renal artery stenosis; Renal Insufficiency, Chronic - diagnostic imaging; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - etiology; Risk Factors; Uric Acid - blood; chronic kidney disease; microalbuminuria; peripheral arterial disease; renal artery stenosis
• ISSN: 0916-9636; 1348-4214; 1348-4214
• DOI: 10.1038/hr.2010.93

The prevalence and risk factors for renal artery stenosis (RAS) and chronic kidney disease (CKD) are unclear in Japanese patients with peripheral arterial disease (PAD). To examine these issues, we performed renal angiography in 410 patients with PAD. Renal function and damage were assessed using the estimated glomerular filtration rate (eGFR) and urinary level of microalbumin (MA). Multiple logistic and multiple regression analyses were used to examine the relationships of potential risk factors with RAS and CKD. In all, 94 subjects (22.9%) had RAS >50% and 45 subjects (11.0%) had RAS >75%. The incidences of an abnormal level of MA and renal insufficiency (eGFR <60 ml min –1 per 1.73 m 2 ) were 37.0 and 60.7%, respectively. RAS ⩾50% was associated with critical limb ischemia (CLI; hazard ratio (HR) 2.519; 95% confidence interval (CI) 1.203–5.276, P =0.014), coronary heart disease (CHD; HR 2.143; 95% CI 1.129–4.069; P =0.020) and hypertension (HR 1.907; 95% CI 1.009–3.628; P =0.045). RAS ⩾75% had a relationship with hypertension (HR 3.093; 95% CI 1.002–9.548; P =0.048). eGFR was negatively correlated with age, uric acid and CHD ( P =0.013), and MA had a significant positive correlation with low-density lipoprotein cholesterol, CLI, age, CHD and diabetes ( P <0.001). These results show that the prevalences of RAS and CKD are very high in Japanese patients with PAD; that CLI and CHD are major risk factors for RAS; and that hyperuricemia, hypercholesterolemia and diabetes are risk factors for CKD in PAD. We also found that MA is a simple and noninvasive marker of renal dysfunction and general vascular damage.