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Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial

OBJECTIVE: A post hoc analysis to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events. RESEARCH DESIGN AND METHODS: LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5–5 years...

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Autores principales: Persson, Frederik, Bain, Stephen C., Mosenzon, Ofri, Heerspink, Hiddo J.L., Mann, Johannes F.E., Pratley, Richard, Raz, Itamar, Idorn, Thomas, Rasmussen, Søren, von Scholten, Bernt Johan, Rossing, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985419/
https://www.ncbi.nlm.nih.gov/pubmed/33504496
http://dx.doi.org/10.2337/dc20-1622
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author Persson, Frederik
Bain, Stephen C.
Mosenzon, Ofri
Heerspink, Hiddo J.L.
Mann, Johannes F.E.
Pratley, Richard
Raz, Itamar
Idorn, Thomas
Rasmussen, Søren
von Scholten, Bernt Johan
Rossing, Peter
author_facet Persson, Frederik
Bain, Stephen C.
Mosenzon, Ofri
Heerspink, Hiddo J.L.
Mann, Johannes F.E.
Pratley, Richard
Raz, Itamar
Idorn, Thomas
Rasmussen, Søren
von Scholten, Bernt Johan
Rossing, Peter
author_sort Persson, Frederik
collection PubMed
description OBJECTIVE: A post hoc analysis to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events. RESEARCH DESIGN AND METHODS: LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5–5 years in 9,340 participants with type 2 diabetes and high cardiovascular risk. We calculated change in urinary albumin-to-creatinine ratio (UACR) from baseline to 1 year in participants with >30% reduction (n = 2,928), 30–0% reduction (n = 1,218), or any increase in UACR (n = 4,124), irrespective of treatment. Using Cox regression, risks of major adverse cardiovascular events (MACE) and a composite nephropathy outcome (from 1 year to end of trial in subgroups by baseline UACR [<30 mg/g, 30–300 mg/g, or ≥300 mg/g]) were assessed. The analysis was adjusted for treatment allocation alone as a fixed factor and for baseline variables associated with cardiovascular and renal outcomes. RESULTS: For MACE, hazard ratios (HRs) for those with >30% and 30–0% UACR reduction were 0.82 (95% CI 0.71, 0.94; P = 0.006) and 0.99 (0.82, 1.19; P = 0.912), respectively, compared with any increase in UACR (reference). For the composite nephropathy outcome, respective HRs were 0.67 (0.49, 0.93; P = 0.02) and 0.97 (0.66, 1.43; P = 0.881). Results were independent of baseline UACR and consistent in both treatment groups. After adjustment, HRs were significant and consistent in >30% reduction subgroups with baseline micro- or macroalbuminuria. CONCLUSIONS: A reduction in albuminuria during the 1st year was associated with fewer cardiovascular and renal outcomes, independent of treatment. Albuminuria monitoring remains an important part of diabetes care, with great unused potential.
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spelling pubmed-79854192021-04-12 Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial Persson, Frederik Bain, Stephen C. Mosenzon, Ofri Heerspink, Hiddo J.L. Mann, Johannes F.E. Pratley, Richard Raz, Itamar Idorn, Thomas Rasmussen, Søren von Scholten, Bernt Johan Rossing, Peter Diabetes Care Cardiovascular and Metabolic Risk OBJECTIVE: A post hoc analysis to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events. RESEARCH DESIGN AND METHODS: LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5–5 years in 9,340 participants with type 2 diabetes and high cardiovascular risk. We calculated change in urinary albumin-to-creatinine ratio (UACR) from baseline to 1 year in participants with >30% reduction (n = 2,928), 30–0% reduction (n = 1,218), or any increase in UACR (n = 4,124), irrespective of treatment. Using Cox regression, risks of major adverse cardiovascular events (MACE) and a composite nephropathy outcome (from 1 year to end of trial in subgroups by baseline UACR [<30 mg/g, 30–300 mg/g, or ≥300 mg/g]) were assessed. The analysis was adjusted for treatment allocation alone as a fixed factor and for baseline variables associated with cardiovascular and renal outcomes. RESULTS: For MACE, hazard ratios (HRs) for those with >30% and 30–0% UACR reduction were 0.82 (95% CI 0.71, 0.94; P = 0.006) and 0.99 (0.82, 1.19; P = 0.912), respectively, compared with any increase in UACR (reference). For the composite nephropathy outcome, respective HRs were 0.67 (0.49, 0.93; P = 0.02) and 0.97 (0.66, 1.43; P = 0.881). Results were independent of baseline UACR and consistent in both treatment groups. After adjustment, HRs were significant and consistent in >30% reduction subgroups with baseline micro- or macroalbuminuria. CONCLUSIONS: A reduction in albuminuria during the 1st year was associated with fewer cardiovascular and renal outcomes, independent of treatment. Albuminuria monitoring remains an important part of diabetes care, with great unused potential. American Diabetes Association 2021-04 2021-01-27 /pmc/articles/PMC7985419/ /pubmed/33504496 http://dx.doi.org/10.2337/dc20-1622 Text en © 2021 by the American Diabetes Association https://www.diabetesjournals.org/content/licenseReaders may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.
spellingShingle Cardiovascular and Metabolic Risk
Persson, Frederik
Bain, Stephen C.
Mosenzon, Ofri
Heerspink, Hiddo J.L.
Mann, Johannes F.E.
Pratley, Richard
Raz, Itamar
Idorn, Thomas
Rasmussen, Søren
von Scholten, Bernt Johan
Rossing, Peter
Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
title Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
title_full Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
title_fullStr Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
title_full_unstemmed Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
title_short Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
title_sort changes in albuminuria predict cardiovascular and renal outcomes in type 2 diabetes: a post hoc analysis of the leader trial
topic Cardiovascular and Metabolic Risk
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985419/
https://www.ncbi.nlm.nih.gov/pubmed/33504496
http://dx.doi.org/10.2337/dc20-1622
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