Cargando…
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...
Autores principales: | , , , , , , , , , , |
---|---|
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 |
_version_ | 1783668243038208000 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7985419 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Diabetes Association |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT perssonfrederik changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT bainstephenc changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT mosenzonofri changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT heerspinkhiddojl changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT mannjohannesfe changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT pratleyrichard changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT razitamar changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT idornthomas changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT rasmussensøren changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT vonscholtenberntjohan changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial AT rossingpeter changesinalbuminuriapredictcardiovascularandrenaloutcomesintype2diabetesaposthocanalysisoftheleadertrial |