{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:40:26Z","timestamp":1777678826621,"version":"3.51.4"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,6,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Patients enrolled in the medical therapy\u2013only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              ) in estimated glomerular filtration rate (\n              <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content>\n              ), defined as a \u226530% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy\u2013only cohort,\n              <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content>\n              was available in 359 subjects at all time points, the subjects were followed for a median of 4.72\u00a0years, and 66 of 359 (18%) subjects experienced an early\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              . Baseline log cystatin C (odds ratio, 1.78 [1.11\u20132.85];\n              <jats:italic>P<\/jats:italic>\n              =0.02), age (odds ratio, 1.04 [1.00\u20131.07];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine\n              <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content>\n              (odds ratio, 1.86 [1.15\u20133.0];\n              <jats:italic>P<\/jats:italic>\n              =0.01) were associated with an early\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              . Despite continued medical therapy only, the\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              group had an improvement in\n              <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content>\n              at 1 year (6.9%;\n              <jats:italic>P<\/jats:italic>\n              =0.04). The\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              and nondecline groups were not significantly different for clinical events and all\u2010cause mortality (\n              <jats:italic>P<\/jats:italic>\n              =0.78 and\n              <jats:italic>P<\/jats:italic>\n              =0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in\n              <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content>\n              at 1\u00a0year in the\n              <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>\n              group was estimated at 5.8\u00b17.1%.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued.<\/jats:p>\n          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Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela S.","family":"Brewster","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haden","family":"Sholl","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Sharrett","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaili","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine R.","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Division of Nephrology University of Washington School of Medicine Providence Sacred Heart Medical Center Spokane WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven T.","family":"Haller","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toledo College of Medicine and Life Sciences Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Jamerson","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Michigan Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy 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