Acute Increases in Serum Creatinine after Starting Angiotensin-Converting Enzyme Inhibitor-Based Therapy and Effects of its Continuation on Major Clinical Outcomes in Type 2 Diabetes Mellitus: The ADVANCE Trial

Toshiaki Ohkuma, Min Jun, Anthony Rodgers, Mark E. Cooper, Paul Glasziou, Pavel Hamet, Stephen Harrap, Giuseppe Mancia, Michel Marre, Bruce Neal, Vlado Perkovic, Neil Poulter, Bryan Williams, Sophia Zoungas, John Chalmers, Mark Woodward

研究成果: ジャーナルへの寄稿記事

10 引用 (Scopus)

抜粋

Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creatinine are unclear. In the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), 11 140 diabetes mellitus patients were randomly assigned to perindopril-indapamide or placebo after a 6-week active run-in period. The current study included 11 066 participants with 2 serum creatinine measurements recorded before and during the active run-in period (3 weeks apart). Acute increase in creatinine was determined using these 2 measurements and classified into 4 groups: increases in serum creatinine of <10%, 10% to 19%, 20% to 29%, and ≥30%. The primary study outcome was the composite of major macrovascular events, new or worsening nephropathy, and all-cause mortality. An acute increase in serum creatinine was associated with an elevated risk of the primary outcome (P for trend <0.001). The hazard ratios were 1.11 (95% CI, 0.97-1.28) for those with an increase of 10% to 19%, 1.34 (1.07-1.66) for 20% to 29%, and 1.44 (1.15-1.81) for ≥30%, compared with <10%. However, there was no evidence of heterogeneity in the benefit of randomized treatment effects on the outcome across subgroups defined by acute serum creatinine increase (P for heterogeneity=0.94). Acute increases in serum creatinine after starting perindopril-indapamide were associated with greater risks of subsequent major clinical outcomes. However, the continuation of angiotensin-converting enzyme inhibitor-based therapy reduced the long-term risk of major clinical outcomes, irrespective of acute increase in creatinine. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00145925.

元の言語英語
ページ(範囲)84-91
ページ数8
ジャーナルHypertension
73
発行部数1
DOI
出版物ステータス出版済み - 1 1 2019

All Science Journal Classification (ASJC) codes

  • Internal Medicine

フィンガープリント Acute Increases in Serum Creatinine after Starting Angiotensin-Converting Enzyme Inhibitor-Based Therapy and Effects of its Continuation on Major Clinical Outcomes in Type 2 Diabetes Mellitus: The ADVANCE Trial' の研究トピックを掘り下げます。これらはともに一意のフィンガープリントを構成します。

  • これを引用

    Ohkuma, T., Jun, M., Rodgers, A., Cooper, M. E., Glasziou, P., Hamet, P., Harrap, S., Mancia, G., Marre, M., Neal, B., Perkovic, V., Poulter, N., Williams, B., Zoungas, S., Chalmers, J., & Woodward, M. (2019). Acute Increases in Serum Creatinine after Starting Angiotensin-Converting Enzyme Inhibitor-Based Therapy and Effects of its Continuation on Major Clinical Outcomes in Type 2 Diabetes Mellitus: The ADVANCE Trial. Hypertension, 73(1), 84-91. https://doi.org/10.1161/HYPERTENSIONAHA.118.12060