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Cited by 48Pulmonary Hypertension Research and TreatmentsHeart Failure Treatment and ManagementVascular Anomalies and Treatments

Impact of declining renal function on outcomes in pulmonary arterial hypertension: a REVEAL registry analysis

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Chakinala, Murali M., Coyne, Daniel W., Benza, Raymond L., Frost, Adaani E., McGoon, Michael D., Hartline, Brian K., Frantz, Robert P., Selej, Mona +3 more·2018·The Journal of Heart and Lung Transplantation
DOI 10.1016/j.healun.2017.10.028
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Abstract

Background Renal dysfunction is associated with abnormal cardiopulmonary hemodynamics, in-hospital death and poor survival in patients with pulmonary arterial hypertension (PAH), and thus it may be a prognostic biomarker. In our analysis we assess the relationship between change in estimated glomerular filtration rate (eGFR) and outcomes in PAH patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL).Methods Overall 2,368 patients were classified into chronic kidney disease (CKD) stages based on baseline eGFR: normal or Stages 1 or 2 (n = 1,699); Stage 3a (n = 399); Stage 3b (n = 196); and Stages 4 or 5 (n = 74). We evaluated the relationship between baseline CKD stage and survival, as well as the composite end-point of survival and freedom from all-cause hospitalization. The relationships between change in eGFR at ≥1 year and these clinical end-points were also evaluated.Results Patients with a ≥10% decline in eGFR from baseline over ≥1 year had a significantly increased risk of death (hazard ratio 1.66; p < 0.0001) and the composite of all-cause hospitalization and death (hazard ratio 1.33; p = 0.002). This decline predicted survival independently of changes in 6-minute walk distance and functional class. However, a ≥10% increase in eGFR was not significantly associated with either end-point.Conclusion In REVEAL, a ≥10% decline in eGFR over ≥1 year independently predicted poorer survival. Thus, eGFR may be a simple and economical biomarker in PAH.

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  • REVEAL 2.0 incorporates estimated GFR and all-cause hospitalizations within the previous six months and is a powerful predictor of mortality and clinical worsening.

    “An updated version of the score, REVEAL 2.0, which incorporates estimated GFR and all-cause hospitalizations within the previous six-months, has emerged as a powerful predictor of mortality and clinical worsening.(285–287)”

    From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [286]

    The Abstract reports that declining eGFR predicted death and the composite of death or all-cause hospitalization in REVEAL patients. But the Baseline characteristics section describes renal function in the risk score as a qualitative assessment, not calculated eGFR. Our copy does not establish that REVEAL 2.0 incorporates eGFR or hospitalizations in the previous six months, or that this updated score predicts mortality and clinical worsening; the paper analyzes eGFR and outcomes rather than validating REVEAL 2.0. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The paper says the REVEAL 2.0 score is a strong predictor of mortality and clinical worsening in pulmonary arterial hypertension, but it has not been prospectively validated.

    “An updated version of the score, REVEAL 2.0, which incorporates estimated GFR and all-cause hospitalizations within the previous six-months, has emerged as a powerful predictor of mortality and clinical worsening.(285–287) Neither of the REVEAL scores has been validated prospectively.”

    From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [286]

    The Discussion describes renal insufficiency as a mortality predictor included in the REVEAL risk score, and the Statistical analysis uses that score for adjustment. Our copy does not address REVEAL 2.0’s predictive performance or prospective validation (searched: REVEAL 2.0, clinical worsening, prospective validation). (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Authors
Chakinala, M. M., Coyne, D. W., Benza, R. L., Frost, A. E., McGoon, M. D., Hartline, B. K., Frantz, R. P., Selej, M., Zhao, C., Mink, D. R., & Farber, H. W.
Affiliations
  • Washington University in St. Louis (US)
  • Houston Methodist (US)
  • Mayo Clinic (US)
  • Actelion (United States) (US)
  • Boston University (US)
Corresponding author
Chakinala, Murali M.
ORCID
Venue
The Journal of Heart and Lung Transplantation
Publisher
Elsevier BV
Published
2018-06
Volume
37
Issue
6
Pages
696-705
ISSN
1053-2498 (ISSN-L)
DOI
10.1016/j.healun.2017.10.028
OpenAlex
W2768011033
Cited by
48
References
25
Citations by year
2026: 4 · 2025: 9 · 2024: 3 · 2023: 11 · 2022: 3 · 2021: 6 · 2020: 3 · 2019: 6 · 2018: 3
FWCI
2.71
Type
journal article
Language
en
Open access
Licence
Locations
  • The Journal of Heart and Lung Transplantation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Actelion Pharmaceuticals
  • Gilead Sciences
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Genetics › Vascular Anomalies and Treatments
Keywords
pulmonary arterial hypertension, chronic kidney disease, estimated glomerular filtration rate, renal function decline, survival, all-cause hospitalization, prognostic factors, REVEAL registry, cardiopulmonary hemodynamics
MeSH terms
Female, Glomerular Filtration Rate, Humans, Hypertension, Pulmonary, Male, Middle Aged, Registries, United States, Renal Insufficiency, Chronic

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