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Changes in Albuminuria and the Risk of Major Clinical Outcomes in Diabetes: Results From ADVANCE-ON
Diabetes Care ( IF 16.2 ) Pub Date : 2018-01-01 , DOI: 10.2337/dc17-1467
Min Jun 1 , Toshiaki Ohkuma 1 , Sophia Zoungas 1, 2 , Stephen Colagiuri 3 , Giuseppe Mancia 4 , Michel Marre 5, 6, 7 , David Matthews 8 , Neil Poulter 9 , Bryan Williams 10 , Anthony Rodgers 1 , Vlado Perkovic 1 , John Chalmers 1 , Mark Woodward 1, 11, 12
Affiliation  

OBJECTIVE To assess the association between 2-year changes in urine albumin–to–creatinine ratio (UACR) and the risk of clinical outcomes in type 2 diabetes.

RESEARCH DESIGN AND METHODS We analyzed data from 8,766 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Post-Trial Observational Study (ADVANCE-ON). Change in UACR was calculated from UACR measurements 2 years apart, classified into three groups: decrease in UACR of ≥30%, minor change, and increase in UACR of ≥30%. By analyzing changes from baseline UACR groups, categorized into thirds, we repeated these analyses accounting for regression to the mean (RtM). The primary outcome was the composite of major macrovascular events, renal events, and all-cause mortality; secondary outcomes were these components. Cox regression models were used to estimate hazard ratios (HRs).

RESULTS Over a median follow-up of 7.7 years, 2,191 primary outcomes were observed. Increases in UACR over 2 years independently predicted a greater risk of the primary outcome (HR for ≥30% UACR increase vs. minor change: 1.26; 95% CI 1.13–1.41), whereas a decrease in UACR was not significantly associated with lower risk (HR 0.93; 95% CI 0.83–1.04). However, after allowing for RtM, the effect of “real” decrease in UACR on the primary outcome was found to be significant (HR 0.84; 95% CI 0.75–0.94), whereas the estimated effect on an increase was unchanged.

CONCLUSIONS Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.



中文翻译:

糖尿病患者蛋白尿的变化和主要临床结局的风险:ADVANCE-ON的结果

目的评估2年糖尿病患者尿白蛋白与肌酐比值(UACR)的2年变化与临床结局风险之间的关系。

研究设计和方法我们分析了来自8766名参与者的糖尿病和血管疾病行动的数据:畸胎前和Diamicron MR对照评估试验后观察性研究(ADVANCE-ON)。根据间隔2年的UACR测量值计算出UACR的变化,分为三组:UACR降低≥30%,细微变化和UACR≥30%。通过分析基线UACR组的变化(分为三部分),我们重复了这些分析,以求回归到均值(RtM)。主要结果是主要大血管事件,肾脏事件和全因死亡率的综合;次要结果是这些组成部分。使用Cox回归模型估算危险比(HRs)。

结果在平均7.7年的随访中,观察到2,191例主要结果。UACR增加超过2年独立预测主要结果的风险较高(HR≥30%UACR增加而轻微变化:1.26; 95%CI 1.13–1.41),而UACR降低与较低风险无显着相关性(HR 0.93; 95%CI 0.83–1.04)。但是,考虑到RtM后,发现UACR的“实际”下降对主要结局的影响是显着的(HR 0.84; 95%CI 0.75-0.94),而对上升的估计影响没有变化。

结论UACR的变化预测了2型糖尿病的主要临床结局和死亡率风险的变化,支持了监测蛋白尿随时间变化的预后效用。

更新日期:2017-12-21
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