The Risk Factors For Renal Artery Stenosis And Its Relationship With Coronary And Peripheral Artery Disease: Systematic Review

Background and objective:Renal artery stenosis( RAS) is a kind of renal artery disease. In our country, the rate of RAS which is caused by the atherosclerosis, is as high as 85%, and it is the most harmful. Once the renal artery appeared atherosclerosis, vascular disease would show a progressive development. Not only could it cause renal vascular hypertension, renal ischemia, but also if the lesion of the narrow made progress to occlusion, the renal function would gradually deteriorate, even some patients would enter the end stage of renal disease. All these factors can affect the quality of patient’s life and long-term prognosis. Therefore, it is important to detect and intervene the patient who has atherosclerotic RAS as soon as possible.Atherosclerosis is a diffuse and systemic vascular disease, and it usually occurs in medium or macro-vascular bed. ARAS is a marker of systemic artery atherosclerotic burden, and a number of studies have shown that ARAS is closely related to coronary artery disease( CAD). In recent years, renal artery angiography was carried out frequently when doctors performed coronary angiography for it could greatly improve the detection and diagnosis rate of RAS. The method was widely used in clinical. But if it is used as a routine examination, it can expand the adaptation scope, and may also lead to some related complications for renal artery, also because the cost is high, it should not be used as a census method.We hope to systematically evaluate the relationship between ARAS and some relative factors, and hope to choose the right patients for renal artery angiograph y. Only in this way, can we avoid expanding the adaptation of renoarteriography.Method:This study include two parts: the first part is about systematically evaluating the traditional risk factors of the ARAS, and analyzing the differences of the danger intensity among those factors; the second part is about evaluating the correlation of ARAS with CAD and peripheral arterial disease( PAD).Part 11、Databases: CBM、 Pub Med、 wan-fang、 Web of science、 CNKI、 VIP and EMBASE;2、Search time: before October 2013;3、Type of Study: all published case-control studies;4、Two reviewers( Liubo and Lvjianfeng) extracted data from the screened documents one by one and independently, according to the observation contents;5、NOS scale was used to evaluate the quality of literature;6、Rev Man5.2 and stata11.0 software were used to conducting Meta-analysis.Part 21、Databases: Pub Med、Web of science、The Cochrane library and EMBASE;2、Search time: before April 2013;3、Type of Study: all published case-control studies about the relation between CAD and PAD;4、Two reviewers( Liubo and Lvjianfeng) extracted data from the screened documents one by one and independently, according to the observation contents;5、NOS scale was used to evaluate the quality of literature;6、Rev Man5.2 and stata11.0 software were used to conducting Meta-analysis.Results:Part 11、About 17 articles debated the gender of the case group and the control group, they included 27247 patients, and the results showed: their OR and 95%CI were 1.31( 1.21,1.42);2、About 15 articles debated the hypertension of the case group and the control group, they included 25062 patients, and the results showed: their OR and 95%CI were 2.42( 2.18, 2.67);3、About 11 articles debated the dyslipidemia of the case group and the control group, they included 22612 patients, and the results showed: their OR and 95%CI were 1.55( 1.18, 2.05);4、About 16 articles debated the diabetes of the case group and the control group, they included 26718 patients, and the results showed: their OR and 95%CI were 1.44( 1.31, 1.58);5、About 5 articles debated the SBP of the case group and the control group, they included 4553 patients, and the results showed: their SMD and 95%CI were 11.08( 5.01, 17.16);6、About 5 articles debated the DBP of the case group and the control group, they included 4553 patients, and the results showed: their SMD and 95%CI were 1.46(-3.09,6.10);Part 21、About 9 articles debated 1- vessel of CAD of the case group and the control group, they included 8237 patients, and the results showed: their OR and 95%CI were 0.70( 0.59, 0.82);2、About 9 articles debated 2- vessel of CAD of the case group and the control group, they included 8237 patients, and the results showed: their OR and 95%CI were 1.28( 1.10, 1.48);3、About 9 articles debated 3- vessel of CAD of the case group and the control group, they included 8237 patients, and the results showed: their OR and 95%CI were 2.09( 1.69, 2.59);4、About 7 articles debated LMCA of CAD of the case group and the control group, they included 6522 patients, and the results showed: their OR and 95%CI were 1.82( 1.40, 2.36);5、About 12 articles debated PAD of the case group and the control group, they included 11639 patients, and the results showed: their OR and 95%CI were 3.68(2.21, 6.10);Conclusion:Part 1Traditional factors like female, hypertension, SBP, diabetes and dyslipidemia have relationship with ARAS, but now we shouldn’t conclude that DBP have an effect on the incidence of ARAS.Part 2CAD( including 2-vessel, 3-vessel and LMCA) and PAD have an effect on the incidence of ARAS, but we cannot draw a conclusion that 1-vessel have an relationship with ARAS.