Renal Vascular Disease Causing End-Stage Renal Disease, Incidence, Clinical Correlates, and Outcomes: A 20-Year Clinical Experience

TLDR

In the United States, end‑stage renal disease incidence has risen sharply over the past eight years, disproportionately affecting elderly white dialysis patients, most of whom are over 70 years old. The study argues that many elderly white hypertensive patients with end‑stage renal disease actually have renal vascular disease and that hypertension should not be used as the diagnosis when clinical criteria indicate otherwise. Renal vascular disease was identified in 83 of 683 dialysis patients via angiography or asymmetric kidney size in the presence of systemic atherosclerosis, hypertension, minimal proteinuria, and benign sediment. Patients with renal vascular disease had markedly low survival—56% at 2 years, 18% at 5 years, and 5% at 10 years—mirroring 1992 USRDS data and showing a significantly worse prognosis than other diagnostic groups.

Abstract

In the United States, the incidence of end-stage renal disease to hypertension has increased sharply over the last 8 years, especially in elderly white dialysis patients who demonstrate very poor survival rates. The 5-year survival rates were near 20% for patients 65 to 74 years old and 9% for those > or = 75 years of age. Our program experienced a sharp increase in cases of end-stage renal disease due to renal vascular disease after 1982. Renal vascular disease was characterized clinically in 83 of 683 dialysis patients either by angiography or asymmetric kidney size in patients with evidence of systemic atherosclerosis, hypertension, insignificant proteinuria, and a benign urinary sediment. The median age was 70 years, with 84% of the patients being older than 61 years. These patients had 56% 2-year, 18% 5-year, and 5% 10-year survival rates, which are quite similar to the 1992 US Renal Data System data. Patients with renal vascular disease have a significantly worse prognosis than other diagnostic groups, most likely due to their older age, underlying vascular disease, and coronary artery disease. We feel that a significant number of elderly white hypertensive patients described in the 1992 US Renal Data Service report have renal vascular disease as a cause of end-stage renal disease, highlighting the need to establish correct renal diagnoses. Hypertension should not be the end-stage renal disease diagnosis in elderly white hypertensive patients if clinical criteria suggest a diagnosis of renal vascular disease.