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. 2016 Sep;105(9):727-37.
doi: 10.1007/s00392-016-0979-8. Epub 2016 Mar 26.

Effects of serelaxin in acute heart failure patients with renal impairment: results from RELAX-AHF

Licette C Y Liu  1 , Adriaan A Voors  2 , John R Teerlink  3 , Gad Cotter  4 , Beth A Davison  4 , G Michael Felker  5 , Gerasimos Filippatos  6 , Yakuan Chen  7 , Barry H Greenberg  8 , Piotr Ponikowski  9 , Peter S Pang  10 , Margaret F Prescott  11 , Tsushung A Hua  11 , Thomas M Severin  11 , Marco Metra  12
Affiliations

Effects of serelaxin in acute heart failure patients with renal impairment: results from RELAX-AHF

Licette C Y Liu et al. Clin Res Cardiol. 2016 Sep.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Acute heart failure; Number needed to treat; Renal function; Renal impairment; Serelaxin.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for cardiovascular (CV) death through day 180 (a upper panel) and all-cause death through day 180 (b lower panel) according to eGFR. eGFR estimated glomerular filtration rate
Fig. 2
Fig. 2
Percentage of death through day 180 in subgroups according to estimated glomerular filtration (eGFR) rate in acute heart failure patients treated with placebo (blue) or serelaxin (red). (1) *p < 0.05; (2) eGFR interval 41.5–51.2 stands for ≥41.5 and <51.2; 51.2–61.2 stands for ≥51.2 and <61.2
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