Abstract 16546: Rapid Decline in Kidney Function Predicts Future Improvement in Estimated GFR in Patients With Atherosclerotic Renal Artery Stenosis When Treated With Medical Therapy Only
Introduction: Several observational studies suggest that atherosclerotic renal artery stenosis (ARAS) patients who experience a rapid decline in kidney function are more likely to improve with renal stenting. Whether this represents the treatment effect of stenting or the natural history of changes in kidney function in this population is unclear. We studied the effect of rapid decline of estimates of Glomerular Filtration Rate (eGFR) in patients with ARAS treated with medical therapy only.
Hypothesis: Rapid decline of eGFR in ARAS patients predicts improved eGFR when treated with medical therapy only.
Methods: Data from the medical therapy only arm of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial was used. Optimal medical therapy included treating blood pressure and diabetes to goal, use of an angiotensin receptor-blocker, statin, and anti-platelet therapy. Glomerular filtration (eGFR) was estimated using the MDRD-GFR equation. A rapid decline was defined as a 30% decline in eGFR at 3- and at 6-months.
Results: There were 472 patients in the medical therapy only group. In the 3-month decline group (n=40) eGFR improved more than in the non-decline eGFR group (n=334) (percent change, 31±36 vs. 1±21, P<0.001). In the 6-month decline group (n=46) eGFR improved more than in the non-decline eGFR group (n=310) (percent change, 22±25 vs. 0±18, P<0.001).
Conclusion: Patients with a rapid decline of eGFR, observed over either a 3- or 6-month interval, are likely to have significantly improved kidney function during 1-year follow-up when treated with medical therapy only. The current study suggests the improvements seen in kidney function in observational studies of renal artery stenting may be related to the natural history of the disorder, and may not be attributable to the stent intervention per se.
Author Disclosures: Y. Xie: None. K. Ren: None. E. Cooper: None. P. Brewster: None. T. Chen: None. H. Nguyen: None. S. Haller: None. D. Kennedy: None. C. Drummond: None. J. Tian: None. C.J. Cooper: None.
- © 2016 by American Heart Association, Inc.