High Plasma Renin Activity May Worsen Outcomes

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VANCOUVER, B.C.—High plasma renin activity (PRA) is associated with adverse renal outcomes in patients with coronary artery disease (CAD), according to study findings presented at the World Congress of Nephrology.

The study, by Joseph B. Muhlestein, MD, of the Intermountain Medical Center in Murray, Utah, and the University of Utah in Salt Lake City, and colleagues, included 1,971 patients with angiographically documengted CAD (vessel stenosis of 50% or greater). The mean follow-up was 5.9 years (maximum 14.8 years).

Compared with patients with low PRA (0.50 ng/mL/hour or less), those with high PRA (greater than 2.30 ng/mL/hour) had a significant 55% increased risk of a new renal diagnosis (ICD 9 diagnosis of renal transplant or dialysis) and 63% increased risk of worsening renal function (greater than 0.5 mg/dL increase in creatinine from baseline) at three years. During long-term follow-up, high PRA was associated with significant 55% and 47% increased risks, respectively.

In addition, moderately elevated PRA (0.51-2.30 ng/mL/hour) was associated with a significant 27% increased risk of a new renal diagnosis during long-term follow-up.

The investigators noted that their study is the first to evaluate the association between baseline PRA and renal outcomes in patients with CAD (defined as 50% or greater stenosis).

The predictive power of PRA was independent of age, gender, hyperlipidemia, hypertension, smoking status, family history of CAD, number of severe vessels, baseline medications, and other variables, the researchers observed.

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