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

13 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

Keywords

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

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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