Renal artery involvement is associated with increased morbidity but not mortality in Takayasu arteritis: a matched cohort study of 215 patients

• Published in: Clinical rheumatology Vol. 43; no. 1; pp. 67 - 80
• Main Authors: Thakare, Darpan R., Mishra, Prabhaker, Rathore, Upendra, Singh, Kritika, Dixit, Juhi, Qamar, Tooba, Behera, Manas Ranjan, Jain, Neeraj, Ora, Manish, Bhadauria, Dharmendra Singh, Gambhir, Sanjay, Kumar, Sudeep, Agarwal, Vikas, Misra, Durga Prasanna
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2024; Springer Nature B.V
• Subjects: Aorta; Arteritis; Cohort Studies; Congestive heart failure; Coronary vessels; Delayed Diagnosis; Heart failure; Heart Failure - complications; Humans; Hypertension; Hypertension - complications; Kidney Failure, Chronic - complications; Medicine; Medicine & Public Health; Morbidity; Mortality; Original Article; Renal artery; Renal Artery - diagnostic imaging; Renal failure; Retrospective Studies; Rheumatology; Survival; Takayasu Arteritis - complications; Takayasu Arteritis - diagnosis; Takayasu's disease; Vein & artery diseases; Veins & arteries; Aortitis syndrome; Takayasu arteritis; Angiography; Interventional radiology; Renal artery stenosis; Renal artery obstruction
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-023-06829-9

Background
We analyzed differences in presentation and survival of Takayasu arteritis (TAK) with or without renal artery involvement (RAI) from a large monocentric cohort of patients with TAK.
Methods
Clinical and angiographic features were compared between TAK with versus without RAI, with bilateral versus unilateral RAI, and with bilateral RAI versus without RAI using multivariable-adjusted logistic regression. Inter-group differences in survival were analyzed [hazard ratios (HR) with 95% confidence intervals (95%CI)] adjusted for gender, age at disease onset, diagnostic delay, baseline disease activity, and significant clinical/angiographic inter-group differences after multivariable-adjustment/propensity score matching (PSM).
Results
Of 215 TAK, 117(54.42%) had RAI [66(56.41%) bilateral]. TAK with RAI or with bilateral RAI had earlier disease onset than without RAI (
p
 < 0.001). Chronic renal failure (CRF) was exclusively seen in TAK with RAI. TAK with RAI (vs without RAI) had more frequent hypertension (
p
 = 0.001), heart failure (
p
 = 0.047), abdominal aorta (
p
 = 0.001) or superior mesenteric artery involvement (
p
 = 0.018). TAK with bilateral RAI (vs unilateral RAI) more often had hypertension (
p
 = 0.011) and blurring of vision (
p
 = 0.049). TAK with bilateral RAI (vs without RAI) more frequently had hypertension (
p
 = 0.002), heart failure (
p
 = 0.036), abdominal aorta (
p
 < 0.001), superior mesenteric artery (
p
 = 0.002), or left subclavian artery involvement (
p
 = 0.041). Despite higher morbidity (hypertension, CRF), mortality risk was not increased with RAI vs without RAI (HR 2.32, 95%CI 0.61–8.78), with bilateral RAI vs unilateral RAI (HR 2.65, 95%CI 0.52–13.42) or without RAI (HR 3.16, 95%CI 0.79–12.70) even after multivariable adjustment or PSM.
Conclusion
RAI is associated with increased morbidity (CRF, hypertension, heart failure) but does not adversely affect survival in TAK.
Key Points
•
Renal artery involvement in TAK is associated with chronic renal failure.
•
TAK with renal artery involvement more often have heart failure and hypertension.
•
Bilateral renal artery involvement (compared with unilateral) is more often associated with hypertension and visual symptoms.
•
Renal artery involvement is not associated with an increased risk of mortality in TAK.