BACKGROUND This study defines clinical variables at the time of renal artery stenting that may be predictors of long-term all-cause mortality. METHODS The data are derived from the single operator, single center, renal stent retrospective study (SOCRATES) and includes a review of 748 (336 men, 412 women) consecutive symptomatic patients with de novo atherosclerotic renal artery stenosis treated over an 11-year period. All patients had clinical indications for renal revascularization, including, but not limited to; suboptimal control of hypertension, chronic kidney disease, and cardiac disturbance syndromes. Clinical variables at the time of the index procedure were evaluated as predictors of all-cause mortality using multivariate analysis. Mortality data were derived from hospital records and formal queries of the State Department of Health and Human Services, Health and Vital Statistics Division database. RESULTS In-hospital, 30-day and 6-month mortality rates were 0.5, 2.0, and 6.3%, respectively. Overall patient survival at years 1, 5, and 10 was 91.2, 66.6, and 40.9%, respectively. Comorbid conditions, including chronic obstructive pulmonary disease and congestive heart failure, were independently associated with increased mortality. There were incremental changes in mortality in patients with baseline azotemia, [preprocedure serum creatinine (sCr) 1.5-2.09 mg/dL hazard ratio 1.52; sCr >2.5 mg/dL hazard ratio 3.39]. Therapy with lipid lowering agents offered a survival advantage (hazard ratio 0.69, P = 0.0.049); however, this study was not designed to evaluate a "protective effect" of lipid lowering medications. CONCLUSIONS Patients with chronic obstructive pulmonary disease and congestive heart failure undergoing renal artery stent revascularization have a poor long-term prognosis. Baseline azotemia is the strongest independent predictor of all cause mortality, with more than 70% of patients with marked azotemia (sCr >2.5) dead at 5 years.