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Prognostic Value of Renal Function in Patients With Pulmonary Arterial Hypertension (PAH) Treated With Epo-A in the PROSPECT Registry

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.22.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Murali Chakinala

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An association between renal insufficiency and mortality has been suggested for patients with World Health Organization Group 1 PAH. PROSPECT is a 1-year prospective, 50-center, observational US registry to evaluate the use of epoprostenol for injection (Veletri®; Epo-A) in routine practice.

Rationale: An association between renal insufficiency and mortality has been suggested for patients with World Health Organization Group 1 PAH. PROSPECT is a 1-year prospective, 50-center, observational US registry to evaluate the use of epoprostenol for injection (Veletri®; Epo-A) in routine practice. This study determined whether change in renal function, as assessed by estimated glomerular filtration rate (eGFR) after the first 3 months of enrollment in PROSPECT, predicts mortality over the next 9 months.

Methods: Patients initiating or already receiving Epo-A were enrolled in PROSPECT. Patient data were collected quarterly for up to 1 year. Data download for this analysis occurred on September 23, 2013. Patients with information necessary to calculate eGFR (by the Chronic Kidney Disease Epidemiology Collaboration equation) at enrollment and at the end of the first quarter (Q1; N = 151) were included. Nine-month survival from Q1 was determined by Kaplan-Meier estimates.

Results: The analysis included 151 patients: 59 (39.1%) had normal eGFR (>90 mL/min/1.73 m2) and 92 (60.9%) had an eGFR ≤90 mL/min/1.73 m2 at enrollment. No patient was on renal replacement therapy at enrollment. Patients who had a normal eGFR at enrollment experienced a mean reduction in eGFR of 8.29% at Q1, whereas patients with abnormal eGFR at enrollment experienced a mean improvement in eGFR of 1.39% at Q1. Among the 151 patients, 45 (29.8%) had a normal eGFR at enrollment and Q1; 64 (42.4%) had an abnormal eGFR at enrollment and/or Q1, and had a reduction in eGFR <10 mL/min/1.73 m2; 42 (27.8%) had an abnormal eGFR at enrollment and/or Q1, and had a reduction in eGFR ≥10 mL/min/1.73 m2. Nine-month survival estimates from Q1 differed significantly only between patients with normal eGFR at enrollment and Q1 and patients with abnormal eGFR at enrollment and/or Q1 who had a reduction in eGFR ≥10 mL/min/1.73 m2 (P=.01).

Conclusions: Based on prospective data from the PROSPECT registry, patients on Epo-A with below normal renal function, defined as eGFR <90 mL/min/1.73m2, that declines by ≥10 mL/min/1.73m2 have worse survival than patients with persistently normal eGFR. The eGFR as a measure of renal function should be further explored as a surrogate marker for survival in patients with PAH.

Type: Clinical Science