Key result
In acute heart failure patients with renal impairment, treatment with serelaxin resulted in a pronounced reduction in 180-day all-cause mortality (HR 0.53) compared to placebo.
Why the study?
Does serelaxin reduce mortality in acute heart failure patients with baseline renal impairment?
RCT (n=1,132)
Double-blind
1:1
Yes
Does serelaxin reduce mortality in acute heart failure patients with baseline renal impairment?
Hazard Ratio: 0.53 (95% CI 0.34–0.83)
Absolute Event Rate: 7.43% vs 13.61%
Number Needed to Treat: 16
Serelaxin appears to significantly reduce mortality in acute heart failure patients with baseline renal impairment, potentially offsetting the excess mortality risk typically associated with renal dysfunction.
May offset excess mortality risk from renal impairment in acute HF; leaves open confirmation in randomized trials.
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.
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Liu et al. (2016) conducted an RCT in Acute heart failure with renal impairment (n=1,132). Serelaxin vs. Placebo was evaluated on 180-day all-cause mortality in patients with renal impairment (eGFR <60 ml/min/1.73 m2) (HR 0.53, 95% CI 0.34-0.83). In acute heart failure patients with renal impairment, treatment with serelaxin resulted in a pronounced reduction in 180-day all-cause mortality (HR 0.53) compared to placebo.
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