A recent analysis of the CORAL trial data suggests that patients with chronic kidney disease (CKD) who successfully responded to renal artery stenting (RAS), a procedure to open narrowed and blocked renal arteries due to disease, had increased rates of event-free survival. The findings were presented at the Society for Vascular Surgery 2016 Annual Meeting in National Harbor, Maryland.
CKD, a condition characterized by progressive deterioration of the renal function, is managed by different treatment methods designed to slow disease progression. A broad principle of management is based on controlling blood pressure and treating the underlying condition, which could be accomplished through approaches such as RAS.
Previous results from the CORAL trial involving 947 patients with renal artery stenosis with or without CKD showed similar outcomes for patients treated with medical therapy alone and those with additional RAS at a median followup of 43 months, according to a press release.
In this study, data from the CORAL trial was analyzed. It included 144 CKD patients whose average age was 71. The participants, predominantly male (61 percent), were randomly treated using RAS combined with an angiotensin receptor blocker.
Depending on the outcomes, the patients were classified as responders, defined as those who had more than a 20 percent increase from baseline in eGFR (glomerular filtration rate) or nonresponders, who had less than 20 percent increase in eGFR from baseline.
The results revealed larger differences in event-free survival between patients, determined by freedom from death, myocardial infarction, stroke or transient ischemic attack, progressive renal insufficiency or renal replacement therapy, and hospitalization for congestive heart failure.
Among the 144 participants, 39 patients (27 percent) responded well to the combined treatment based on RAS plus angiotensin receptor blockade. The average increase of eGFR of the responders was 41 percent over baseline, while a reduction by 8 percent was recorded with the non-responder group.
The researchers concluded that the responders to RAS had better event-free survival than nonresponders, measured in terms of higher preoperative eGFR and elevated degree of improvement over eGFR. Conversely, peripheral artery disease and elevated preoperative systolic blood pressure were recorded as predictors of poor outcomes.