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

Murali M. Chakinala, Daniel W. Coyne, Raymond L. Benza, Adaani E. Frost, Michael D. McGoon, Brian K. Hartline, Robert P. Frantz, Mona Selej, Carol Zhao, David R. Mink, Harrison W. Farber

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23 Scopus citations


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.

Original languageEnglish
Pages (from-to)696-705
Number of pages10
JournalJournal of Heart and Lung Transplantation
Issue number6
StatePublished - Jun 2018


  • biomarker
  • chronic kidney disease
  • glomerular filtration rate
  • pulmonary arterial hypertension
  • serum creatinine


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