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J Am Heart Assoc. 2019 Jun 4;8(11):e012366. doi: 10.1161/JAHA.119.012366. Epub 2019 Jun 1.

Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis.

Author information

1
Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH.
2
Division of Nephrology University of Washington School of Medicine Providence Sacred Heart Medical Center Spokane WA.
3
Department of Medicine University of Michigan Ann Arbor MI.
4
Department of Diagnostic Imaging Rhode Island Hospital and Alpert Medical School of Brown University Providence RI.
5
Department of Biostatistics School of Public Health Boston University Boston MA.
6
University of Texas Health Science Center San Antonio TX.
7
Department of Medicine Harvard University Beth Israel Deaconess Medical Center Boston MA.
8
Joan C. Edwards School of Medicine Marshall University Huntington WV.

Abstract

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.

KEYWORDS:

cardiovascular disease; renal; renal artery stenosis; renal disease; renovascular; renovascular hypertension

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