Pos0703 renal artery stenosis is not associated with worse survival in takayasu arteritis – data from a single-center retrospective cohort of 195 patients

Background Renal artery stenosis (RAS) is more frequent in Asian patients with Takayasu arteritis (TAK). Few studies have assessed the impact of RAS on the presentation and prognosis of TAK using adjusted analysis. Objectives To compare the presentation and prognosis between TAK with or without RAS. Methods We compared the clinical presentation and vascular involvement (including angiographic subtypes by Hata’s classification) between patients with TAK with or without RAS, with bilateral versus unilateral RAS, and with bilateral RAS versus those without RAS using multivariable-adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) derived after logistic regression. We compared survival between these groups using hazard ratios (HR) with 95%CI adjusted for gender, age at disease onset, delay to diagnosis, baseline disease activity, and inter-group differences. The institute ethics committee provided a waiver of consent for retrospective data retrieval. The institute ethics committee provided a waiver of consent for retrospective data retrieval. Results Out of 195 TAK with imaging data available, 106 had RAS [58 bilateral, 48 unilateral; mean(±SD) follow-up 41.50(±43.35) months]. TAK with RAS (mean age 22.99 years) or bilateral RAS (mean age 22.83 years) were younger than without RAS (mean age 28.00 years). TAK with RAS had more hypertension (aOR 4.46, 95%CI 1.81 – 10.99), lower limb claudication (aOR 2.72, 95%CI 1.08 – 6.88), and less frequent upper limb claudication (aOR 0.43, 95%CI 0.19-0.99) and syncope or dizziness (aOR 0.35, 95%CI 0.14 – 0.85) than TAK without RAS. TAK with bilateral RAS had more frequent hypertension (aOR 11.83, 95%CI 1.38-101.16), blurring of vision (aOR 5.97, 95%CI 1.02 – 34.83), and less frequent constitutional symptoms (aOR 0.18, 95%CI 0.06 – 0.51) than those with unilateral RAS. TAK with bilateral RAS had more frequent hypertension (aOR 8.73, 95%CI 1.90-40.06), vascular bruits (aOR 2.94, 95%CI 1.03 – 8.34), and heart failure (aOR 4.16, 95%CI 1.00 – 17.32), and less frequent constitutional symptoms (aOR 0.23, 95%CI 0.09 – 0.62), pulse loss (aOR 0.29, 95%CI 0.11 – 0.77), and syncope or dizziness (aOR 0.21, 95%CI 0.06-0.73) than those without RAS. Hata’s type IV and type V were more frequent in TAK with versus without RAS (OR 4.01 and 13.40, respectively), and in those with bilateral RAS versus no RAS (OR 5.97 and 10.94, respectively). Adjusted survival was similar between TAK with or without RAS, with unilateral or bilateral RAS, or with bilateral RAS vs those without RAS (Table 1). Conclusion RAS is associated with specific clinical and angiographic features but not with a greater risk of mortality in TAK. Table 1. Risk estimates for the association of RAS with mortality in TAK Exposure Cox regression models* Hazard ratio (95%CI) With (n=101) vs without RAS (n=86) Unadjusted 3.55(0.75–16.83) A, B, C, PGA 6.33(0.60–67.06) A, B, C, DEI.Tak 3.48(0.37–33.18) A, B, C, ITAS2010 4.00(0.42–37.96) Bilateral (n=56) vs unilateral RAS (n=45) Unadjusted 2.82(0.56–14.23) A, D, PGA 2.47(0.26–23.59) A, D, DEI.Tak 2.39(0.29–19.75) A, D, ITAS2010 2.57(0.33–20.32) Bilateral RAS (n=56) vs without RAS (n=86) Unadjusted 5.04(1.01–25.22) A, E, F, PGA 7.46(0.25–226.04) A, E, F, DEI.Tak 7.95(0.48–131.12) A, E, F, ITAS2010 9.52(0.57–160.30) *Covariates adjusted for A – Chosen a priori - Gender, age at disease onset, delay to diagnosis B – Distinct clinical features-syncope/dizziness/vertigo, upper limb claudication, lower limb claudication, hypertension C – Distinct vascular involvement–left carotid artery, abdominal aorta, or the superior mesenteric artery. D – Distinct clinical features– Constitutional symptoms, blurring of vision, hypertension E – Distinct clinical features– Constitutional symptoms, syncope/dizziness/vertigo, pulse loss, vascular bruits, hypertension, heart failure. F – Distinct vascular involvement-left subclavian artery, abdominal aorta, superior mesenteric artery. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.