Effects of stenting for atherosclerotic renal artery stenosis on eGFR and predictors of clinical events in the CORAL trial

Katherine R. Tuttle, Lance D. Dworkin, William Henrich, Barbara A. Greco, Michael Steffes, Sheldon Tobe, Joseph I. Shapiro, Kenneth Jamerson, Asya Lyass, Karol Pencina, Joseph M. Massaro, Ralph B. D’Agostino, Donald E. Cutlip, Timothy P. Murphy, Christopher J. Cooper

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background and objectives Atherosclerotic renal artery stenosis may cause kidney function loss, but effects of stenting on eGFR and clinical events associated with CKD are uncertain. Our study objectives were to determine effects of stenting on eGFR and predictors of clinical events. Design, setting, participants, & measurements: Participants (n=931) in the Cardiovascular Outcomes in Renal Artery Stenosis Trial (fromMay of 2005 to September of 2012) had >60% atherosclerotic renal artery stenosis and systolic hypertension on two or more antihypertensive drugs and/or stage >3 CKD. The intervention was stenting versus no stenting on a background of risk factor management: renin-angiotensin system inhibition, statin, antiplatelet therapy, and smoking cessation education. The effect of stenting on eGFR by the serum creatinine-cystatin C Chronic Kidney Disease Epidemiology Collaboration equation was the prespecified analysis of kidney function. Predictors of eGFR and CKD outcomes (>30% eGFR loss, ESRD, and death) and cardiovascular disease outcomes (stroke, myocardial infarction, heart failure, and death) controlling for eGFR and albuminuria were also determined. Results: eGFR was 59±24 ml/min per 1.73 m2 (mean±SD) at baseline. Over 3 years, eGFR change, assessed by generalized estimating equations, was-1.5±7.0ml/min per 1.73m2 per year in the stent group versus-2.3±6.3 ml/min per 1.73 m2 per year in the medical therapy only group (P=0.18). eGFR predictors (multiple variable generalized estimating equations) were age, albuminuria, systolic BP, and diabetes (inverse associations) as well as men, total cholesterol, andHDL cholesterol (positive associations). CKDoutcomes events occurred in 19%(175 of 931), and predictors (Cox proportional hazards models) included albuminuria (positive association), systolic BP (positive association), and HDL cholesterol (inverse association). Cardiovascular disease outcomes events occurred in 22% (207 of 931), and predictors included age, albuminuria, total cholesterol, prior cardiovascular disease, and bilateral atherosclerotic renal artery stenosis (positive associations). Conclusions: Stenting did not influence eGFR in participants with atherosclerotic renal artery stenosis receiving renin-angiotensin system inhibition-based therapy. Predictors of clinical events were traditional risk factors for CKD and cardiovascular disease.

Original languageEnglish (US)
Pages (from-to)1180-1188
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number7
DOIs
StatePublished - 2016

Bibliographical note

Funding Information:
The authors appreciate the support and encouragement provided by Diane M. Reid (Medical Officer, Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute [NHLBI], Bethesda, MD). The Cardiovascular Outcomes in Renal Artery Stenosis Clinical Trial was supported by NHLBI of the National Institutes of Health grants U01HL071556, U01HL072734, U01HL072735, U01HL072736, and U01HL072737. Study drugs were provided by Astra Zeneca and Pfizer Inc. Study devices were provided by Cordis Corporation, and supplemental financial support was granted by both Cordis Corporation and Pfizer Inc. None of the sponsors had roles in design andconduct of the study; collection, management, analysis, and interpretation of the data; or review or approval of the manuscript. The content of this paper is solely the responsibility of the authors.

Publisher Copyright:
© 2016 by the American Society of Nephrology.

Keywords

  • Albuminuria
  • Blood pressure
  • Cardiovascular disease
  • Chronic kidney disease
  • Glomerular filtration rate
  • Hypertension
  • Renal Artery Obstruction
  • Renin angiotensin system
  • Stents

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