Journal
CLINICAL RESEARCH IN CARDIOLOGY
Volume 105, Issue 9, Pages 727-737Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00392-016-0979-8
Keywords
Serelaxin; Acute heart failure; Renal function; Renal impairment; Number needed to treat
Categories
Funding
- Alere
- Bayer
- Cardio3Biosciences
- Celladon
- Ceva
- European Committee
- Dutch Heart Foundation
- Novartis
- Servier
- Torrent
- Vifor
- Amgen
- Corthera
- Cardio3 Bioscience
- Cytokinetics
- Merck
- Takeda
- Teva
- Trevena
- Otsuka
- Roche Diagnostics
- NHLBI
- European Union
- Abbott
- PDL BioPharma
- Novartis Pharma
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Serelaxin showed beneficial effects on clinical outcome and trajectories of renal markers in patients with acute heart failure. We aimed to study the interaction between renal function and the treatment effect of serelaxin. In the current post hoc analysis of the RELAX-AHF trial, we included all patients with available estimated glomerular filtration rate (eGFR) at baseline (n = 1132). Renal impairment was defined as an eGFR < 60 ml/min/1.73 m(2) estimated by creatinine. 817 (72.2 %) patients had a baseline eGFR < 60 ml/min/1.73 m(2). In placebo-treated patients, baseline renal impairment was related to a higher 180 day cardiovascular (HR 3.12, 95 % CI 1.33-7.30) and all-cause mortality (HR 2.81, 95 % CI 1.34-5.89). However, in serelaxin-treated patients, the risk of cardiovascular and all-cause mortality was less pronounced (HR 1.19, 95 % CI 0.54 -2.64; p for interaction = 0.106, and HR 1.15 95 % CI 0.56-2.34 respectively; p for interaction = 0.088). In patients with renal impairment, treatment with serelaxin resulted in a more pronounced all-cause mortality reduction (HR 0.53, 95 % CI 0.34-0.83), compared with patients without renal impairment (HR 1.30, 95 % CI 0.51-3.29). Renal dysfunction was associated with higher cardiovascular and all-cause mortality in placebo-treated patients, but not in serelaxin-treated patients. The observed reduction in (cardiovascular) mortality in RELAX-AHF was more pronounced in patients with renal dysfunction. These observations need to be confirmed in the ongoing RELAX-AHF-2 trial.
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