Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis
Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovasc...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012366 |
| _version_ | 1811332622354219008 |
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| author | Emily L. Cooper Yanmei Xie Hanh Nguyen Pamela S. Brewster Haden Sholl Megan Sharrett Kaili Ren Tian Chen Katherine R. Tuttle Steven T. Haller Kenneth Jamerson Timothy P. Murphy Ralph B. D'Agostino Joseph M. Massaro William Henrich Christopher J. Cooper Donald E. Cutlip Lance D. Dworkin Joseph I. Shapiro |
| author_facet | Emily L. Cooper Yanmei Xie Hanh Nguyen Pamela S. Brewster Haden Sholl Megan Sharrett Kaili Ren Tian Chen Katherine R. Tuttle Steven T. Haller Kenneth Jamerson Timothy P. Murphy Ralph B. D'Agostino Joseph M. Massaro William Henrich Christopher J. Cooper Donald E. Cutlip Lance D. Dworkin Joseph I. Shapiro |
| author_sort | Emily L. Cooper |
| collection | DOAJ |
| description | Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy–only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD. Baseline log cystatin C (odds ratio, 1.78 [1.11–2.85]; P=0.02), age (odds ratio, 1.04 [1.00–1.07]; P<0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15–3.0]; P=0.01) were associated with an early RD. Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P=0.04). The RD and nondecline groups were not significantly different for clinical events and all‐cause mortality (P=0.78 and P=0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued. |
| first_indexed | 2024-04-13T16:39:43Z |
| format | Article |
| id | doaj.art-1e8aa1abb4fd4f1dbcdeb190f5752505 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:39:43Z |
| publishDate | 2019-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1e8aa1abb4fd4f1dbcdeb190f57525052022-12-22T02:39:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-06-0181110.1161/JAHA.119.012366Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery StenosisEmily L. Cooper0Yanmei Xie1Hanh Nguyen2Pamela S. Brewster3Haden Sholl4Megan Sharrett5Kaili Ren6Tian Chen7Katherine R. Tuttle8Steven T. Haller9Kenneth Jamerson10Timothy P. Murphy11Ralph B. D'Agostino12Joseph M. Massaro13William Henrich14Christopher J. Cooper15Donald E. Cutlip16Lance D. Dworkin17Joseph I. Shapiro18Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDivision of Nephrology University of Washington School of Medicine Providence Sacred Heart Medical Center Spokane WADepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine University of Michigan Ann Arbor MIDepartment of Diagnostic Imaging Rhode Island Hospital and Alpert Medical School of Brown University Providence RIDepartment of Biostatistics School of Public Health Boston University Boston MADepartment of Biostatistics School of Public Health Boston University Boston MAUniversity of Texas Health Science Center San Antonio TXDepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHDepartment of Medicine Harvard University Beth Israel Deaconess Medical Center Boston MADepartment of Medicine University of Toledo College of Medicine and Life Sciences Toledo OHJoan C. Edwards School of Medicine Marshall University Huntington WVBackground Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy–only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD. Baseline log cystatin C (odds ratio, 1.78 [1.11–2.85]; P=0.02), age (odds ratio, 1.04 [1.00–1.07]; P<0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15–3.0]; P=0.01) were associated with an early RD. Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P=0.04). The RD and nondecline groups were not significantly different for clinical events and all‐cause mortality (P=0.78 and P=0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued.https://www.ahajournals.org/doi/10.1161/JAHA.119.012366cardiovascular diseaserenalrenal artery stenosisrenal diseaserenovascularrenovascular hypertension |
| spellingShingle | Emily L. Cooper Yanmei Xie Hanh Nguyen Pamela S. Brewster Haden Sholl Megan Sharrett Kaili Ren Tian Chen Katherine R. Tuttle Steven T. Haller Kenneth Jamerson Timothy P. Murphy Ralph B. D'Agostino Joseph M. Massaro William Henrich Christopher J. Cooper Donald E. Cutlip Lance D. Dworkin Joseph I. Shapiro Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular disease renal renal artery stenosis renal disease renovascular renovascular hypertension |
| title | Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis |
| title_full | Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis |
| title_fullStr | Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis |
| title_full_unstemmed | Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis |
| title_short | Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis |
| title_sort | early rapid decline in kidney function in medically managed patients with atherosclerotic renal artery stenosis |
| topic | cardiovascular disease renal renal artery stenosis renal disease renovascular renovascular hypertension |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012366 |
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