Bilateral Renal Artery Stenosis Prevalence and Clinical Outcomes: A Systematic Review and Meta-Analysis

Q: What are the key findings of this study?

Bilateral renal artery stenosis had a pooled prevalence of 6.2% across five studies with substantial heterogeneity.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Bilateral renal artery stenosis (n=5972). Intervention: Bilateral renal artery stenosis (and exploratory revascularization therapy) vs. Conservative (medical) therapy. Primary outcome: Pooled prevalence of bilateral renal artery stenosis (95% CI 1.8%-18.7%, p=<0.0001 for heterogeneity).

Q: What does this research mean for the field?

The pooled prevalence of bilateral renal artery stenosis is approximately 6.2% across high-risk clinical populations but demonstrates marked heterogeneity, with limited exploratory evidence suggesting revascularization may lower mortality and heart failure hospitalizations. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the pooled prevalence of bilateral renal artery stenosis compared to unilateral disease and explore clinical outcomes, including mortality and heart failure hospitalization following revascularization.

Kamran Hasni; Taylor Campbell

doi:10.36959/832/414

July 7, 2026Annals of NephrologyOpen Access

Bilateral Renal Artery Stenosis Prevalence and Clinical Outcomes: A Systematic Review and Meta-Analysis

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Key result

Bilateral renal artery stenosis shows a pooled prevalence of ~6% across studies.

95% CI 1.8%-18.7%
P<0.0001 for heterogeneity
n=5,972

Why the study?

The prevalence of bilateral renal artery stenosis compared with unilateral renal artery stenosis and its associated clinical outcomes, including mortality with revascularization therapy and heart failure hospitalization, required thorough assessment.

What is the prevalence of bilateral renal artery stenosis and does revascularization therapy reduce mortality and heart failure hospitalization compared with medical therapy?

Key Points

To determine the pooled prevalence of bilateral renal artery stenosis compared to unilateral disease and explore clinical outcomes, including mortality and heart failure hospitalization following revascularization.
Systematic review and random-effects meta-analysis analyzing 6 studies comprising 5,972 patients with cardiovascular or renal conditions identified across academic databases.
Conducted subgroup analyses based on stenosis severity thresholds (≥ 75% vs ≥ 50-70%) alongside sensitivity analyses.
Performed exploratory analyses evaluating clinical outcomes including mortality, heart failure hospitalizations, and blood pressure changes between revascularization and conservative medical management.
The pooled prevalence of bilateral renal artery stenosis was 6.2% (95% CI: 1.8%-18.7%) with high heterogeneity (I2 = 98.4%), which rose to 7.7% (95% CI: 1.1%-37.9%) in sensitivity cohorts; subgroup differences were not statistically significant (p = 0.075).
In an exploratory single-study analysis, revascularization (n = 52) resulted in lower mortality than conservative medical therapy (n = 33) at 10% versus 39.40% (p = 0.041; OR 0.16).
Heart failure hospitalization in the single-study analysis occurred in 13.60% of revascularized patients compared with 38.50% receiving conservative therapy (p = 0.016; OR 0.24).

Study Design

Type

Meta-Analysis (n=5,972)

Multicenter

Yes

Structured PICO

What is the prevalence of bilateral renal artery stenosis and does revascularization therapy reduce mortality and heart failure hospitalization compared with medical therapy?

P

Population

5,972 predominantly older male adults across 6 studies undergoing coronary angiography, vascular surgery, or evaluation for chronic kidney disease and renovascular hypertension.

E

Exposure

Revascularization therapy (in exploratory outcome analysis of 1 study, n=52)

C

Comparator

Conservative medical therapy (in exploratory outcome analysis of 1 study, n=33)

O

Outcome

Pooled prevalence of bilateral renal artery stenosishard clinical

Main Result

p-value: p=<0.0001 for heterogeneity

Limitations

Small number of included studies reduces statistical power and limits the reliability of subgroup analyses
Extremely high heterogeneity undermines interpretability
Variability in diagnostic modalities, disease severity thresholds, and highly selected patient populations contributed to bias and inconsistent findings
Exploratory clinical outcome analyses were limited to a single study
Small number of included studies reducing statistical power and limiting reliability of subgroup analyses
Extremely high heterogeneity undermining interpretability
High risk of bias in patient selection due to inclusion of highly selected populations (coronary angiography, vascular surgery, pre-existing renal dysfunction)

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Answers are grounded in this paper and cite their sources.

Implication

Bilateral renal artery stenosis has a low but highly heterogeneous pooled prevalence of 6.2% in selected clinical cohorts, and while exploratory single-study data suggest lower mortality and heart failure hospitalization with revascularization, robust prospective evidence is lacking.

Abstract

Objective : This paper examines the prevalence and clinical outcomes of bilateral renal artery stenosis. Conducting a systematic review and meta-analysis enables a thorough assessment of bilateral renal artery stenosis. The objective of this paper is to determine the prevalence of bilateral renal artery stenosis compared with unilateral renal artery stenosis, and to conduct exploratory analyses of clinical outcomes, including the odds of mortality with revascularization therapy and heart failure hospitalization. Methods : Six studies published on academic databases were analyzed and used in this analysis. A random-effects meta-analysis of proportions was performed, subgroup analyses were conducted based on stenosis severity thresholds, sensitivity analyses, and exploratory analyses of clinical outcomes such as mortality and heart failure hospitalization were completed. Results : The meta-analyses showed that the pooled prevalence of bilateral RAS was 6.2% (95% CI: 1.8%-18.7%) with high heterogeneity (I 2 = 98.4%). Including sensitivity cohorts increased the prevalence to 7.7% (95% CI: 1.1%–37.9%), with high heterogeneity. Subgroup differences were not statistically significant (p = 0.075). Conclusion : The prevalence of bilateral renal artery stenosis is low but highly variable, limiting generalizability. Improved clinical outcomes with revascularization are limited and require further research.

Discussion

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Cite This Study

Hasni et al. (2026) conducted a meta-analysis in Bilateral renal artery stenosis (n=5,972). Bilateral renal artery stenosis (and exploratory revascularization therapy) vs. Conservative (medical) therapy was evaluated on Pooled prevalence of bilateral renal artery stenosis (95% CI 1.8%-18.7%, p=<0.0001 for heterogeneity). Bilateral renal artery stenosis had a pooled prevalence of 6.2% across five studies with substantial heterogeneity.

synapsesocial.com/papers/6af0cd87afd0f3f56e51a1eb https://doi.org/10.36959/832/414

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Bilateral Renal Artery Stenosis Prevalence and Clinical Outcomes: A Systematic Review and Meta-Analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Bilateral Renal Artery Stenosis Prevalence and Clinical Outcomes: A Systematic Review and Meta-Analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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