Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001

Abstract

Conclusion: Atherosclerotic renovascular (ARVD) disease is increasing in frequency in patients beginning renal replacement therapy. Summary: The incidence of patients beginning renal replacement therapy almost doubled from 1991 to 2000. It is projected to increase by another 50% by 2015 (J Am Soc Neph 2005;16:3736-41). End-stage renal disease (ESRD) secondary to ARVD has an incidence of 3.7 cases/1000 patient-years (Kidney Int 2005;68: 293-301). As the population ages, it is expected the incidence of ESRD secondary to ARVD will also increase. This study sought to examine the epidemiology of ARVD in dialysis patients. The primary objective was to examine annual trends in the proportion of patients with ARVD starting dialysis therapy. The United States (US) Renal Data System was used to identify patients beginning dialysis between 1996 and 2001. Only patients aged ≥67 years old were considered (n = 146,973). ARVD was identified by examining Medicare claims from the previous 2 years. From 1996 to 2001, prior ARVD identified in patients beginning dialysis increased from 7.1% to 11.2% (adjusted odds ratio [AOR], 1.68). Other associations included ESRD secondary to hypertension (AOR, 2.21), peripheral vascular disease (AOR, 2.65), or to a urologic cause (AOR, 0.57); black race (AOR, 0.44), age >85 years (AOR, 0.58), and inability to ambulate or transfer (AOR, 0.67). The rise in ARVD was not reflected in the proportion of patients with ARVD disease listed as a cause of ESRD at inception of dialysis (5.5% in 1996; 5.0% in 2001). There was considerable variation in the frequency of ARVD diagnosis in different regions of the country and in the use of revascularization as treatment for ARVD in different geographic regions and within subpopulations of the US population. Comment: This is a complicated article, but several points are worth mentioning. First, it appears that the incidence of ARVD as a source of ESRD is increasing. Second, although the proportion of patients with ESRD secondary to ARVD is low compared with other causes, it is still a large number of people. Third, it is disturbing that the diagnosis and treatment of ARVD varies by geographic region and with various subgroups of the population. This suggests regional over-treatment or under-treatment, or societal barriers, or both, to care in patients with ARVD.