Renal artery stenosis in patients with type 2 diabetes mellitus: clinical signs, diagnosis, prognostic value


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Aim. To define the prevalence, clinical features, risk factors, and prognostic value of atherosclerotic renal artery stenosis (RAS) in patients with type 2 diabetes mellitus (T2DM).
Subects and methods. One hundred and fifty-seven T2DM patients (63 males and 94 females) aged over 50 years were examined. Screening for RAS was carried out by duplex ultrasound scanning (DUSS); the diagnosis was verified by multispiral computed tomography and magnetic resonance imaging. Moreover, the detection rate of RAS was analyzed from the selective angiographic readings of 30 patients with T2DM and 26 coronary angiography patients without DM who had undergone coronary angiography (CA).
Results. In the total group of T2DM patients, the RAS detection rate was 36.9%, as evidenced by DUSS and 43.3% by selective renal artery angiography in the patients who had undergone CA. The factors associated with the development of RAS were smoking (relative risk (RR) = 3.3; p < 0.001); atherosclerosis of coronary (RR = 4.28; p < 0.001) and peripheral (RR = 3.38; p < 0.02) arteries, isolated systolic hypertension (RR = 3.9; p < 0.01), and anemia (RR = 6.4; p < 0.001). In patients with T2DM, RAS was one of the important factors of progressive renal and cardiac diseases and increased mortality determined by the combined end point: death, emergency hospitalization for heart failure, myocardial infarction, double creatinine, and end-stage renal failure (RR = 6.28; p < 0.001).
Conclusion. The optimization of prognosis in T2DM patients with RAS requires its timely clinical identification in combination with other types of renal lesion, aggressive correction of the mechanisms of the progressive process, and development of medical and endovascular therapies.

About the authors

M Sh Shamkhalova

Endocrinology Research Center, Moscow

Email: shamkhalova@mail.ru
Endocrinology Research Center, Moscow

I I Klefortova

Endocrinology Research Center, Moscow

Email: iklefort@mail.ru
Endocrinology Research Center, Moscow

M V Shestakova

Endocrinology Research Center, Moscow

Endocrinology Research Center, Moscow

O V Remizov

Endocrinology Research Center, Moscow

Endocrinology Research Center, Moscow

A I Bukhman

Endocrinology Research Center, Moscow

Endocrinology Research Center, Moscow

V A Alpenidze

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

E F Tugeeva

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

M A Sharia

Russian Cardiology Research-and-Production Complex, Moscow

Russian Cardiology Research-and-Production Complex, Moscow

D V Ustyuzhanin

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, MoscowRussian Cardiology Research-and-Production Complex, Moscow

Email: d-ust@yandex.ru
A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, MoscowRussian Cardiology Research-and-Production Complex, Moscow

Yu I Buziashvili

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

A. N. Bakulev Research Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

I I Dedov

Endocrinology Research Center, Moscow

Endocrinology Research Center, Moscow

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