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CORAL: Good response to renal artery stenting confers positive CKD outcomes

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Patients with chronic kidney disease who responded well to renal artery stenting had improved rates of event-free survival, according to a post hoc analysis of the CORAL trial.

Researchers analyzed 144 patients (median age, 71 years; 61% men) from the CORAL trial with chronic kidney disease (CKD) who were randomly assigned to renal artery stenting plus treatment with an angiotensin receptor blocker. Patients were stratified into responders ( 20% increase from baseline in estimated glomerular filtration rate [eGFR]) or nonresponders (< 20% increase from baseline in eGFR).

In the main results of the study of 947 patients with renal artery stenosis with or without CKD, there was no difference in outcomes between those assigned renal artery stenting plus medical therapy and those assigned medical therapy alone. Median follow-up was 43 months.

In the present analysis, the outcome of interest was event-free survival, defined as freedom from death, MI, stroke or transient ischemic attack, hospitalization for congestive HF, progressive renal insufficiency or renal replacement therapy. J. Gregory Modrall, MD, professor of surgery at University of Texas Southwestern Medical Center, Dallas, presented the findings at the Society for Vascular Surgery 2016 Vascular Annual Meeting.

J. Gregory Modrall

At late follow-up, 39 patients (27%) were responders to renal artery stenting plus angiotensin receptor blockade.

The responder group had a median increase of 41% eGFR over baseline (interquartile range, 29-62), whereas the nonresponder group had a median decrease of 8% (interquartile range, –28 to –8; P < .0001), according to the researchers.

Compared with nonresponders, event-free survival occurred more frequently in responders (log-rank P = .0153), Modrall and colleagues found.

Predictors of good outcomes included higher preoperative eGFR and higher degree of improvement on eGFR after stenting, whereas predictors of poor outcomes included peripheral artery disease and high preoperative systolic BP. – by Erik Swain

Reference:

Modrall JG, et al. Plenary Session 6: RS18. Presented at: Society for Vascular Surgery 2016 Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.

Disclosure: Modrall reports no relevant financial disclosures.