Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial

H. J.L. Heerspink, Toshiharu Ninomiya, F. Persson, B. M. Brenner, P. Brunel, N. Chaturvedi, A. S. Desai, S. M. Haffner, J. J.V. Mcmurray, S. D. Solomon, M. A. Pfeffer, H. H. Parving, D. de Zeeuw

研究成果: ジャーナルへの寄稿記事

25 引用 (Scopus)

抄録

Aims: To investigate whether the degree of albuminuria reduction observed in the ALTITUDE trial is associated with renal and cardiovascular protection, and secondly, whether the reduction in albuminuria was too small to afford clinical benefit. Methods: In a post hoc analysis of the ALTITUDE trial in 8561 patients with type 2 diabetes and chronic kidney disease or cardiovascular disease we examined the effect of albuminuria changes at 6 months on renal and cardiovascular outcomes using Cox proportional hazard regression. Results: The median change in albuminuria in the first 6 months in the aliskiren arm of the trial was -12% (25th to 75th percentile: -48.7_to_ +41.9%) and 0.0% (25th to 75th percentile: -40.2_to_55%) in the placebo arm. Changes in albuminuria in the first 6 months were linearly associated with renal and cardiovascular endpoints: a >30% reduction in albuminuria in the first 6 months was associated with a 62% reduction in renal risk and a 25% reduction in cardiovascular risk compared with an increase in albuminuria. The association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar in the two treatment groups (p for interaction >0.1 for both endpoints). Conclusions: The addition of aliskiren to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy resulted in albuminuria changes that were associated with renal and cardiovascular risk changes. This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm.

元の言語英語
ページ(範囲)169-177
ページ数9
ジャーナルDiabetes, Obesity and Metabolism
18
発行部数2
DOI
出版物ステータス出版済み - 2 1 2016

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Albuminuria
Kidney
Placebos
Angiotensin Receptor Antagonists
Chronic Renal Insufficiency
Angiotensin-Converting Enzyme Inhibitors
Type 2 Diabetes Mellitus
Cardiovascular Diseases

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

これを引用

Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial. / Heerspink, H. J.L.; Ninomiya, Toshiharu; Persson, F.; Brenner, B. M.; Brunel, P.; Chaturvedi, N.; Desai, A. S.; Haffner, S. M.; Mcmurray, J. J.V.; Solomon, S. D.; Pfeffer, M. A.; Parving, H. H.; de Zeeuw, D.

:: Diabetes, Obesity and Metabolism, 巻 18, 番号 2, 01.02.2016, p. 169-177.

研究成果: ジャーナルへの寄稿記事

Heerspink, HJL, Ninomiya, T, Persson, F, Brenner, BM, Brunel, P, Chaturvedi, N, Desai, AS, Haffner, SM, Mcmurray, JJV, Solomon, SD, Pfeffer, MA, Parving, HH & de Zeeuw, D 2016, 'Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial', Diabetes, Obesity and Metabolism, 巻. 18, 番号 2, pp. 169-177. https://doi.org/10.1111/dom.12600
Heerspink, H. J.L. ; Ninomiya, Toshiharu ; Persson, F. ; Brenner, B. M. ; Brunel, P. ; Chaturvedi, N. ; Desai, A. S. ; Haffner, S. M. ; Mcmurray, J. J.V. ; Solomon, S. D. ; Pfeffer, M. A. ; Parving, H. H. ; de Zeeuw, D. / Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial. :: Diabetes, Obesity and Metabolism. 2016 ; 巻 18, 番号 2. pp. 169-177.
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title = "Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial",
abstract = "Aims: To investigate whether the degree of albuminuria reduction observed in the ALTITUDE trial is associated with renal and cardiovascular protection, and secondly, whether the reduction in albuminuria was too small to afford clinical benefit. Methods: In a post hoc analysis of the ALTITUDE trial in 8561 patients with type 2 diabetes and chronic kidney disease or cardiovascular disease we examined the effect of albuminuria changes at 6 months on renal and cardiovascular outcomes using Cox proportional hazard regression. Results: The median change in albuminuria in the first 6 months in the aliskiren arm of the trial was -12{\%} (25th to 75th percentile: -48.7_to_ +41.9{\%}) and 0.0{\%} (25th to 75th percentile: -40.2_to_55{\%}) in the placebo arm. Changes in albuminuria in the first 6 months were linearly associated with renal and cardiovascular endpoints: a >30{\%} reduction in albuminuria in the first 6 months was associated with a 62{\%} reduction in renal risk and a 25{\%} reduction in cardiovascular risk compared with an increase in albuminuria. The association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar in the two treatment groups (p for interaction >0.1 for both endpoints). Conclusions: The addition of aliskiren to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy resulted in albuminuria changes that were associated with renal and cardiovascular risk changes. This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm.",
author = "Heerspink, {H. J.L.} and Toshiharu Ninomiya and F. Persson and Brenner, {B. M.} and P. Brunel and N. Chaturvedi and Desai, {A. S.} and Haffner, {S. M.} and Mcmurray, {J. J.V.} and Solomon, {S. D.} and Pfeffer, {M. A.} and Parving, {H. H.} and {de Zeeuw}, D.",
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T1 - Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial

AU - Heerspink, H. J.L.

AU - Ninomiya, Toshiharu

AU - Persson, F.

AU - Brenner, B. M.

AU - Brunel, P.

AU - Chaturvedi, N.

AU - Desai, A. S.

AU - Haffner, S. M.

AU - Mcmurray, J. J.V.

AU - Solomon, S. D.

AU - Pfeffer, M. A.

AU - Parving, H. H.

AU - de Zeeuw, D.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Aims: To investigate whether the degree of albuminuria reduction observed in the ALTITUDE trial is associated with renal and cardiovascular protection, and secondly, whether the reduction in albuminuria was too small to afford clinical benefit. Methods: In a post hoc analysis of the ALTITUDE trial in 8561 patients with type 2 diabetes and chronic kidney disease or cardiovascular disease we examined the effect of albuminuria changes at 6 months on renal and cardiovascular outcomes using Cox proportional hazard regression. Results: The median change in albuminuria in the first 6 months in the aliskiren arm of the trial was -12% (25th to 75th percentile: -48.7_to_ +41.9%) and 0.0% (25th to 75th percentile: -40.2_to_55%) in the placebo arm. Changes in albuminuria in the first 6 months were linearly associated with renal and cardiovascular endpoints: a >30% reduction in albuminuria in the first 6 months was associated with a 62% reduction in renal risk and a 25% reduction in cardiovascular risk compared with an increase in albuminuria. The association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar in the two treatment groups (p for interaction >0.1 for both endpoints). Conclusions: The addition of aliskiren to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy resulted in albuminuria changes that were associated with renal and cardiovascular risk changes. This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm.

AB - Aims: To investigate whether the degree of albuminuria reduction observed in the ALTITUDE trial is associated with renal and cardiovascular protection, and secondly, whether the reduction in albuminuria was too small to afford clinical benefit. Methods: In a post hoc analysis of the ALTITUDE trial in 8561 patients with type 2 diabetes and chronic kidney disease or cardiovascular disease we examined the effect of albuminuria changes at 6 months on renal and cardiovascular outcomes using Cox proportional hazard regression. Results: The median change in albuminuria in the first 6 months in the aliskiren arm of the trial was -12% (25th to 75th percentile: -48.7_to_ +41.9%) and 0.0% (25th to 75th percentile: -40.2_to_55%) in the placebo arm. Changes in albuminuria in the first 6 months were linearly associated with renal and cardiovascular endpoints: a >30% reduction in albuminuria in the first 6 months was associated with a 62% reduction in renal risk and a 25% reduction in cardiovascular risk compared with an increase in albuminuria. The association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar in the two treatment groups (p for interaction >0.1 for both endpoints). Conclusions: The addition of aliskiren to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy resulted in albuminuria changes that were associated with renal and cardiovascular risk changes. This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm.

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DO - 10.1111/dom.12600

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JO - Diabetes, Obesity and Metabolism

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