Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial
Rationale & Objective: Although renal artery stenosis (RAS) and heart failure (HF) have been linked, the incidence and predictors of HF among patients with RAS are not well described. Study Design: Post hoc analysis of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) mult...
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Elsevier
2025-02-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059524001596 |
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| author | Rajesh Gupta Michelle M. Estrella Rebecca Scherzer Pamela S. Brewster Lance D. Dworkin Hanh T. Nguyen Yanmei Xie Joachim H. Ix Michael G. Shlipak Timothy P. Murphy Donald E. Cutlip Eldrin F. Lewis Christopher J. Cooper |
| author_facet | Rajesh Gupta Michelle M. Estrella Rebecca Scherzer Pamela S. Brewster Lance D. Dworkin Hanh T. Nguyen Yanmei Xie Joachim H. Ix Michael G. Shlipak Timothy P. Murphy Donald E. Cutlip Eldrin F. Lewis Christopher J. Cooper |
| author_sort | Rajesh Gupta |
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| description | Rationale & Objective: Although renal artery stenosis (RAS) and heart failure (HF) have been linked, the incidence and predictors of HF among patients with RAS are not well described. Study Design: Post hoc analysis of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) multicenter, open-label, randomized controlled trial (RCT). Settings and Participants: Patients with atherosclerotic RAS and elevated blood pressure, chronic kidney disease, or both, and without a history of HF at enrollment. Intervention: Medical therapy alone versus medical therapy plus renal artery stenting. Outcomes: Incident HF events. Results: This analysis included 808 participants enrolled in the CORAL trial without evidence of baseline HF. During a median follow-up of 4.8 years, 54 participants (6.7%) developed incident HF. HF incidence rates did not differ by randomized intervention (HR, 0.84; 95% confidence interval [CI], 0.49-1.43 for stent arm with medical arm as reference). Baseline diabetes (subdistribution hazard ratio (sHR), 2.07; 95% CI, 1.20-3.58), albuminuria (sHR, 1.12 per doubling of urinary albumin-creatinine ratio, 95% CI, 1.02-1.24), lower eGFR (sHR, 0.78 per 10 mL/min/1.73 m2 estimated glomerular filtration rate calculated with cystatin C and creatinine, 95% CI, 0.69-0.88), and peripheral vascular disease (PVD) (sHR, 2.18, 95% CI, 1.21-3.91) were independent predictors of incident HF. Participants who experienced incident HF had greater kidney function decline before HF events. Limitations: This is a post hoc analysis of a RCT. The number of HF events is small. Conclusions: In patients with RAS, rates of incident HF did not differ between participants randomized to optimal medical therapy alone versus optimal medical therapy plus renal artery stenting. The presence of diabetes, PVD, and worse kidney health at baseline were associated with future HF events. Plain-Language Summary: Renal artery stenosis has been linked with heart failure. The CORAL randomized controlled trial has the largest study population of participants with renal artery stenosis. In this analysis, we assessed the incidence and predictors of heart failure in CORAL. We found similar rates of incident heart failure among participants randomized to medical therapy alone vs. medical therapy plus renal artery stent. We identified independent predictors of incident heart failure among people with renal artery stenosis include PAD, diabetes, albuminuria, and lower baseline eGFR. In addition, eGFR declined prior to heart failure events. |
| format | Article |
| id | doaj-art-650a2246c4cd4a6c990d6525a5a1377a |
| institution | Kabale University |
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| publishDate | 2025-02-01 |
| publisher | Elsevier |
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| series | Kidney Medicine |
| spelling | doaj-art-650a2246c4cd4a6c990d6525a5a1377a2025-01-18T05:05:08ZengElsevierKidney Medicine2590-05952025-02-0172100948Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL TrialRajesh Gupta0Michelle M. Estrella1Rebecca Scherzer2Pamela S. Brewster3Lance D. Dworkin4Hanh T. Nguyen5Yanmei Xie6Joachim H. Ix7Michael G. Shlipak8Timothy P. Murphy9Donald E. Cutlip10Eldrin F. Lewis11Christopher J. Cooper12Division of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH; Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH; Address for Correspondence: Rajesh Gupta, MD, University of Toledo, Division of Cardiovascular Medicine, 3000 Arlington Avenue, MS#1118, Toledo, Ohio 43614.Kidney Health Research Collaborative, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco, CAKidney Health Research Collaborative, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco, CADepartment 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, OHNephrology Section, Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California, San Diego, CAKidney Health Research Collaborative, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco, CASumma Therapeutics, LLC, Cambridge, MABeth Israel Deaconess Medical Center and Baim Institute for Clinical Research, Boston, MACardiovascular Division, Stanford University, Stanford, CADivision of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OHRationale & Objective: Although renal artery stenosis (RAS) and heart failure (HF) have been linked, the incidence and predictors of HF among patients with RAS are not well described. Study Design: Post hoc analysis of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) multicenter, open-label, randomized controlled trial (RCT). Settings and Participants: Patients with atherosclerotic RAS and elevated blood pressure, chronic kidney disease, or both, and without a history of HF at enrollment. Intervention: Medical therapy alone versus medical therapy plus renal artery stenting. Outcomes: Incident HF events. Results: This analysis included 808 participants enrolled in the CORAL trial without evidence of baseline HF. During a median follow-up of 4.8 years, 54 participants (6.7%) developed incident HF. HF incidence rates did not differ by randomized intervention (HR, 0.84; 95% confidence interval [CI], 0.49-1.43 for stent arm with medical arm as reference). Baseline diabetes (subdistribution hazard ratio (sHR), 2.07; 95% CI, 1.20-3.58), albuminuria (sHR, 1.12 per doubling of urinary albumin-creatinine ratio, 95% CI, 1.02-1.24), lower eGFR (sHR, 0.78 per 10 mL/min/1.73 m2 estimated glomerular filtration rate calculated with cystatin C and creatinine, 95% CI, 0.69-0.88), and peripheral vascular disease (PVD) (sHR, 2.18, 95% CI, 1.21-3.91) were independent predictors of incident HF. Participants who experienced incident HF had greater kidney function decline before HF events. Limitations: This is a post hoc analysis of a RCT. The number of HF events is small. Conclusions: In patients with RAS, rates of incident HF did not differ between participants randomized to optimal medical therapy alone versus optimal medical therapy plus renal artery stenting. The presence of diabetes, PVD, and worse kidney health at baseline were associated with future HF events. Plain-Language Summary: Renal artery stenosis has been linked with heart failure. The CORAL randomized controlled trial has the largest study population of participants with renal artery stenosis. In this analysis, we assessed the incidence and predictors of heart failure in CORAL. We found similar rates of incident heart failure among participants randomized to medical therapy alone vs. medical therapy plus renal artery stent. We identified independent predictors of incident heart failure among people with renal artery stenosis include PAD, diabetes, albuminuria, and lower baseline eGFR. In addition, eGFR declined prior to heart failure events.http://www.sciencedirect.com/science/article/pii/S2590059524001596Albuminuriacardiorenal syndromeheart failurerenal artery stenosis |
| spellingShingle | Rajesh Gupta Michelle M. Estrella Rebecca Scherzer Pamela S. Brewster Lance D. Dworkin Hanh T. Nguyen Yanmei Xie Joachim H. Ix Michael G. Shlipak Timothy P. Murphy Donald E. Cutlip Eldrin F. Lewis Christopher J. Cooper Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial Kidney Medicine Albuminuria cardiorenal syndrome heart failure renal artery stenosis |
| title | Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial |
| title_full | Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial |
| title_fullStr | Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial |
| title_full_unstemmed | Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial |
| title_short | Incident Heart Failure in Atherosclerotic Renal Artery Stenosis: A Post Hoc Analysis of the CORAL Trial |
| title_sort | incident heart failure in atherosclerotic renal artery stenosis a post hoc analysis of the coral trial |
| topic | Albuminuria cardiorenal syndrome heart failure renal artery stenosis |
| url | http://www.sciencedirect.com/science/article/pii/S2590059524001596 |
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