| Abstract | Objectives: The aims of this study were to determine the incidence of renal artery stenosis
(RAS) in patients undergoing diagnostic coronary angiography for stable coronary artery
disease (CAD) or suspected coronary artery disease. Additionally, to investigate the
influence of risk factors and certain clinical characteristics on the risk of finding significant
RAS during diagnostic coronary angiography.
Patients and methods: Systematic review and quantitative meta-analysis included a total
of 28 observational cohort studies that were primarily designed to determine the prevalence
and risk factors for RAS in patients with coronary artery disease. The main outcomes of
interest were the mean incidence of significant, severe, and bilateral RAS in the previously
described population, statistically adjusted for individual study size. The second objective
was to investigate the potential association of established cardiovascular risk factors,
comorbidities, and angiographic parameters of the severity of coronary disease with the
frequency of RAS. Relative risk (RR) with 95% confidence interval (95% CI) was used as
the main outcome measure, and a random effect model and the Mantel-Haenszel statistical
algorithm were used for meta-analysis.
Results: The average frequency of RAS in the mentioned population was 13,82% (95% CI
10,69-17,27%), 6,46% (95% CI 4,36-8,95%) and 4,03% (95% CI 2,58-5,78%) for
significant, severe and bilateral RAS. Chronic kidney disease was associated with almost
3-fold higher relative risk for RAS (RR 2,80, 95% CI 2,03-3,38), followed by peripheral
artery disease (RR 2,46, 95% CI 1,85-3,27), left-main artery disease (RR 1,86, 95% CI 1,30-
2,67) and three-vessel disease (RR 1,56, 95% CI 1,28-1,90). Of the classic risk factors for
cardiovascular disease, arterial hypertension (RR 1,33, 95% CI 1,22-1,45), diabetes (RR
1,22, 95% CI 1,09-1,37) and dyslipidemia (RR 1,12, 95% CI 1,06-1,19) were significant
associated with a higher relative risk for significant RAS. Smoking was not significantly
associated with a higher risk of RAS (RR 1,02, 95% CI 0,94-1,12). Female gender was
associated with a 33% higher relative risk for RAS compared to the male gender (RR 1,33,
95% CI 1,07-1,66). Finally, patients with RAS were significantly older that those without
RAS (+4,6 years of age, 95% CI 3,50-5,02).
Conclusion: This study showed that significant RAS is present in nearly 14 out of 100
patients undergoing routine cardiac catheterization for coronary artery disease. Variables
that were significantly associated with a higher risk of finding RAS were older age, female
sex, chronic kidney disease, peripheral artery disease, diabetes mellitus, arterial
hypertension, and dyslipidemia. Of the angiographic variables, RAS was found to be
significantly more frequent in patients with left-main disease and three-vessel disease. |
| Abstract (croatian) | Ciljevi: Glavni ciljevi ove studije su bili utvrditi učestalost stenoze bubrežnih arterija (SBA) u
bolesnika koji se podvrgavaju dijagnostičkoj koronarnoj angiografiji zbog stabilne koronarne
bolesti (kroničnog koronarnog sindroma) ili sumnje na koronarnu bolest. Također je cilj bio
istražiti utjecaj čimbenika rizika i određenih kliničkih karakteristika na rizik pronalaska
značajne SBA za vrijeme dijagnostičke koronarografije.
Pacijenti i metode: Sustavni pregled i kvantitativna meta-analiza su uključile ukupno 28
opservacijskih presječnih istraživanja koja su bila primarno osmišljena s ciljem utvrđivanja
prevalencije i rizičnih faktora za nastanak SBA u bolesnika s koronarnom bolesti. Glavni ishodi
od interesa su bili srednja učestalost značajne, teške i bilateralne SBA u prethodno opisanoj
populaciji, statistički prilagođeno za veličinu pojedinačnih studija. Drugi cilj je bio istražiti
potencijalnu povezanost etabliranih kardiovaskularnih čimbenika rizika, komorbiditeta te
angiografskih parametara težine koronarne bolesti sa učestalosti SBA. Relativni rizik (RR) sa
95%-tnim intervalima pouzdanosti (95% CI) je korišten kao glavna mjera ishoda, a model s
nasumičnim učinicima i Mantel-Haenszel statističkim algoritmom je korišten za meta-analizu.
Rezultati: Prosječna učestalost SBA u navedenoj populaciji iznosila je 13,82% (95% CI 10,69-
17,27%), 6,46% (95% CI 4,36-8,95%) te 4,03% (95% CI 2,58-5,78%) za značajnu, tešku i
bilateralnu SBA. Kronična bubrežna bolest je bila povezana sa gotovo 3-puta većim relativnim
rizikom za SBA (RR 2,80, 95% CI 2,03-3,38), nakon čega je slijedila periferna arterijska bolest
(RR 2,46, 95% CI 1,85-3,27), stenoza debla lijeve koronarne arterije (RR 1,86, 95% CI 1,30-
2,67) te trožilna koronarna bolest (RR 1,56, 95% CI 1,28-1,90). Od klasičnih čimbenika rizika
za kardiovaskularnu bolest, arterijska hipertenzija (RR 1,33, 95% CI 1,22-1,45), šećerna bolest
(RR 1,22, 95% CI 1,09-1,37) i dislipidemija (RR 1,12, 95% CI 1,06-1,19) bili su značajno
povezani sa većim relativnim rizikom za značajnu SBA. Pušenje nije bilo značajno povezano
sa većim rizikom za SBA (RR 1,02, 95% CI 0,94-1,12). Ženski spol je bio povezan sa 33%
višim relativnim rizikom za SBA u odnosu na muški spol (RR 1,33, 95% CI 1,07-1,66).
Konačno, bolesnici sa SBA su bili značajno stariji od onih kojima nije pronađena SBA (+4,6
godina starosti, 95% CI 3,50-5,02).
Zaključci: Ovo istraživanje je pokazalo da je značajna SBA prisutna u gotovo 14 od 100
bolesnika koji se podvrgavaju rutinskoj kateterizaciji srca zbog koronarne bolesti. Varijable
koje su bile značajno povezane sa većim rizikom za pronalazak SBA bile su starija životna dob,
ženski spol, kronična bubrežna bolest, periferna arterijska bolest, šećerna bolest, arterijska hipertenzija te dislipidemija. Od angiografskih varijabli pronađeno je da je SBA značajno učestalija u bolesnika sa stenozom debla i trožilnom koronarnom bolesti. |
