title: Effects of Stenting for Atherosclerotic Renal Artery Stenosis on eGFR and Predictors of Clinical Events in the CORAL Trial.
abstract: 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.
  
  
  
  Participants (n=931) in the Cardiovascular Outcomes in Renal Artery Stenosis Trial (from May 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.
  
  
  
  eGFR was 59±24 ml/min per 1.73 m(2) (mean±SD) at baseline. Over 3 years, eGFR change, assessed by generalized estimating equations, was -1.5±7.0 ml/min per 1.73 m(2) per year in the stent group versus -2.3±6.3 ml/min per 1.73 m(2) 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, and HDL cholesterol (positive associations). CKD outcomes 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).
  
  
  
  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.
authors.affiliation: Providence Health Care, University of Washington, Spokane, Washington.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Tuttle
authors.affiliation: Brown University, Providence, Rhode Island.|Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Lance D
authors.initials: LD
authors.lastname: Dworkin
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Henrich
authors.affiliation: Baystate Health, Springfield, Massachusetts.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Greco
authors.affiliation: University of Minnesota, Minneapolis, Minnesota.
authors.forename: Michael
authors.initials: M
authors.lastname: Steffes
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Tobe
authors.affiliation: Marshall University, Huntington, West Virginia.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.affiliation: Harvard Clinical Research Institute, Boston University, Boston, Massachusetts.
authors.forename: Asya
authors.initials: A
authors.lastname: Lyass
authors.affiliation: Harvard Clinical Research Institute, Boston University, Boston, Massachusetts.
authors.forename: Karol
authors.initials: K
authors.lastname: Pencina
authors.affiliation: Harvard Clinical Research Institute, Boston University, Boston, Massachusetts.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.affiliation: Harvard Clinical Research Institute, Boston University, Boston, Massachusetts.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.affiliation: Brown University, Providence, Rhode Island.|Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.affiliation: University of Toledo, Toledo, Ohio.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
mesh_terms: D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology*; D008076:Cholesterol, HDL / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012078:Renal Artery Obstruction / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012737:Sex Factors; D016540:Smoking Cessation; D015607:Stents
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D008076:Cholesterol, HDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Renal Artery Obstruction; Stents; albuminuria; blood pressure; cardiovascular disease; chronic kidney disease; glomerular filtration rate; hypertension; renin angiotensin system