Relationship of albuminuria and renal artery stent outcomes

Timothy P. Murphy; Christopher J. Cooper; Karol M. Pencina; Ralph D’Agostino; Joseph Massaro; Donald E. Cutlip; Kenneth Jamerson; Alan H. Matsumoto; William Henrich; Joseph I. Shapiro; Katherine R. Tuttle; David J. Cohen; Michael Steffes; Qi Gao; Christopher C. Metzger; William B. Abernethy; Stephen C. Textor; John Briguglio; Alan T. Hirsch; Sheldon Tobe; Lance D. Dworkin

doi:10.1161/HYPERTENSIONAHA.116.07744

Relationship of albuminuria and renal artery stent outcomes

Timothy P. Murphy, Christopher J. Cooper, Karol M. Pencina, Ralph D’Agostino, Joseph Massaro, Donald E. Cutlip, Kenneth Jamerson, Alan H. Matsumoto, William Henrich, Joseph I. Shapiro, Katherine R. Tuttle, David J. Cohen, Michael Steffes, Qi Gao, Christopher C. Metzger, William B. Abernethy, Stephen C. Textor, John Briguglio, Alan T. Hirsch, Sheldon TobeLance D. Dworkin

Research output: Contribution to journal › Article › peer-review

50 Scopus citations

Abstract

Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease- or kidney disease-related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P=0.02), cardiovascular disease-related death (93% versus 85%; P≤ 0.01), progressive renal insufficiency (91% versus 77%; P=0.03), and overall survival (89% versus 76%; P≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00081731.

Original language	English (US)
Pages (from-to)	1145-1152
Number of pages	8
Journal	Hypertension
Volume	68
Issue number	5
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.116.07744
State	Published - Nov 1 2016

Bibliographical note

Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Numbers U01HL071556, U01HL072734, U01HL072735, U01HL072736, and U01HL072737. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Drug for this study was provided by AstraZeneca (Wilmington, DE), device support was provided by Cordis Corporation (Bridgewater, NJ), and supplemental financial support was granted by Cordis Corporation and Pfizer Inc

Publisher Copyright:
© 2016 American Heart Association, Inc.

Keywords

arteriosclerosis
myocardial infarction
renal artery obstruction
renal insufficiency
stents
stroke

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Murphy, T. P., Cooper, C. J., Pencina, K. M., D’Agostino, R., Massaro, J., Cutlip, D. E., Jamerson, K., Matsumoto, A. H., Henrich, W., Shapiro, J. I., Tuttle, K. R., Cohen, D. J., Steffes, M., Gao, Q., Metzger, C. C., Abernethy, W. B., Textor, S. C., Briguglio, J., Hirsch, A. T., ... Dworkin, L. D. (2016). Relationship of albuminuria and renal artery stent outcomes. Hypertension, 68(5), 1145-1152. https://doi.org/10.1161/HYPERTENSIONAHA.116.07744

Murphy, TP, Cooper, CJ, Pencina, KM, D’Agostino, R, Massaro, J, Cutlip, DE, Jamerson, K, Matsumoto, AH, Henrich, W, Shapiro, JI, Tuttle, KR, Cohen, DJ, Steffes, M, Gao, Q, Metzger, CC, Abernethy, WB, Textor, SC, Briguglio, J, Hirsch, AT, Tobe, S & Dworkin, LD 2016, 'Relationship of albuminuria and renal artery stent outcomes', Hypertension, vol. 68, no. 5, pp. 1145-1152. https://doi.org/10.1161/HYPERTENSIONAHA.116.07744

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abstract = "Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease- or kidney disease-related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P=0.02), cardiovascular disease-related death (93% versus 85%; P≤ 0.01), progressive renal insufficiency (91% versus 77%; P=0.03), and overall survival (89% versus 76%; P≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00081731.",

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note = "Funding Information: This work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Numbers U01HL071556, U01HL072734, U01HL072735, U01HL072736, and U01HL072737. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Drug for this study was provided by AstraZeneca (Wilmington, DE), device support was provided by Cordis Corporation (Bridgewater, NJ), and supplemental financial support was granted by Cordis Corporation and Pfizer Inc Publisher Copyright: {\textcopyright} 2016 American Heart Association, Inc.",

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AU - Jamerson, Kenneth

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N2 - Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease- or kidney disease-related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P=0.02), cardiovascular disease-related death (93% versus 85%; P≤ 0.01), progressive renal insufficiency (91% versus 77%; P=0.03), and overall survival (89% versus 76%; P≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00081731.

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KW - stents

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Relationship of albuminuria and renal artery stent outcomes

Abstract

Bibliographical note

Keywords

UN SDGs

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