Characteristics and Medium-term Outcomes of Takayasu Arteritis–related Renal Artery Stenosis: Analysis of a Large Chinese Cohort
Ying Sun, Xiaomin Dai, Peng Lv, Zhihui Dong, Lingying Ma, Yan Yan, Jiang Lin, Lindi Jiang
Abstract
Objective. To investigate the characteristics of patients with Takayasu arteritis (TA)-related renal artery stenosis and identify the predictors of medium-term adverse outcomes. Methods. Data for 567 patients registered in the East China Takayasu arteritis cohort, a large prospective observational cohort, up to April 30, 2019, were retrospectively analyzed. Results. Renal artery stenosis was confirmed in 172/567 (30.34%) patients, with left renal artery involvement seen in 73/172 (42.44%) patients. Renal insufficiency at presentation (HR 2.37, 95% CI 1.76–15.83, P = 0.03), bilateral renal artery involvement (HR 6.95, 95% CI 1.18–21.55, P = 0.01), and severe stenosis (> 75%; HR 4.75, 95% CI 1.08–11.33, P = 0.05) were predictors of adverse outcomes. A matrix model constructed using 3 variables (renal function, stenosis severity, and bilateral renal artery involvement) could identify 3 risk groups. Revascularization was performed for 46 out of 172 (26.74%) patients. Patients without preoperative treatment had higher rate of restenosis (41.46% vs 16.67%, P < 0.01) and worsening hypertension (25.93% vs. 10.53%, P < 0.01) after the procedure. Nonreceipt of preoperative treatment (HR 6.5, 95% CI 1.77–32.98, P = 0.04) and active disease at revascularization (HR 4.21, 95% CI 2.01–21.44, P = 0.04) were independent predictors of adverse outcomes after revascularization. Conclusion. Patients with TA-associated renal artery stenosis and uncontrolled or worsening hypertension or/and renal function may benefit from revascularization. Those who have received preoperative treatment may have more favorable revascularization outcomes. Prognosis appears to be poorer for patients with renal insufficiency at presentation, bilateral artery involvement, and severe stenosis.