Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH.
Division of Nephrology University of Washington School of Medicine Providence Sacred Heart Medical Center Spokane WA.
J Am Heart Assoc. 2019 Jun 4;8(11):e012366. doi: 10.1161/JAHA.119.012366. Epub 2019 Jun 1.
Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy-only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy-only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD. Baseline log cystatin C (odds ratio, 1.78 [1.11-2.85]; P=0.02), age (odds ratio, 1.04 [1.00-1.07]; P<0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15-3.0]; P=0.01) were associated with an early RD. Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P=0.04). The RD and nondecline groups were not significantly different for clinical events and all-cause mortality (P=0.78 and P=0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued.
在开始药物治疗后，患有动脉粥样硬化性肾动脉狭窄的患者可能会出现肾功能的早期快速下降。其原因和后果尚不清楚。
在 CORAL（肾脏动脉病变的心血管结局）研究的仅药物治疗组中，对估计肾小球滤过率（eGFR）的快速下降（RD）进行评估，定义为从基线到 3 个月或 6 个月或两者均下降≥30%。在仅药物治疗组中，所有时间点均有 359 例患者可获得 eGFR，中位随访时间为 4.72 年，359 例患者中有 66 例（18%）发生早期 RD。基线胱抑素 C 对数（比值比，1.78[1.11-2.85]；P=0.02）、年龄（比值比，1.04[1.00-1.07]；P<0.05）和慢性肾脏病流行病学合作组肌酐 eGFR（比值比，1.86[1.15-3.0]；P=0.01）与早期 RD 相关。尽管仅继续药物治疗，RD 组在 1 年时 eGFR 仍有改善（6.9%；P=0.04）。RD 组和无下降组在临床事件和全因死亡率方面无显著差异（P=0.78 和 P=0.76）。同样，RD 组中有 1 例（1.5%）和无下降组中有 6 例（2%）需要进行肾脏替代治疗。RD 组在 1 年时 eGFR 改善的回归平均值估计为 5.8±7.1%。
当开始药物治疗时，患有肾动脉狭窄的患者可能会出现肾功能的早期快速下降，而当仅继续药物治疗时，其临床结局与没有这种下降的患者相当。
