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Kanda E, Usui T, Kashihara N, Iseki C, Iseki K, Nangaku M. Importance of glomerular filtration rate change as surrogate endpoint for the future incidence of end-stage renal disease in general Japanese population: community-based cohort study. Clin Exp Nephrol 2017; 22:318-327. [PMID: 28884361 PMCID: PMC5838149 DOI: 10.1007/s10157-017-1463-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/16/2017] [Indexed: 11/24/2022]
Abstract
Background Because of the necessity for extended period and large costs until the event occurs, surrogate endpoints are indispensable for implementation of clinical studies to improve chronic kidney disease (CKD) patients’ prognosis. Methods Subjects with serum creatinine level for a baseline period over 1–3 years were enrolled (n = 69,238) in this community-based prospective cohort study in Okinawa, Japan, and followed up for 15 years. The endpoint was end-stage renal disease (ESRD). The percent of estimated glomerular filtration rate (%eGFR) change was calculated on the basis of the baseline period. Results Subjects had a mean ± SD age, 55.59 ± 14.69 years; eGFR, 80.15 ± 21.15 ml/min/1.73 m2. Among the subjects recruited, 15.81% had a low eGFR (<60 ml/min/1.73 m2) and 36.1/100,000 person years developed ESRD. Cox proportional hazards models adjusted for baseline characteristics showed that the risk of ESRD tended to be high with high rates of decrease in %eGFR changes over 2 or 3 years in the high- and low-eGFR groups. The specificities and positive predictive values for ESRD based on a cutoff value of %eGFR change of less than −30% over 2 or 3 years were high in the high- and low-eGFR groups. Conclusions %eGFR change tends to be associated with the risk of ESRD. %eGFR change of less than −30% over 2 or 3 years can be a candidate surrogate endpoint for ESRD in the general Japanese population.
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Affiliation(s)
- Eiichiro Kanda
- Department of Nephrology, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro, Tokyo, 153-8934, Japan. .,Life Science and Bioethics Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tomoko Usui
- Division of Health Service Promotion, The University of Tokyo, Tokyo, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Chiho Iseki
- Okinawa Heart and Renal Association, Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Kunitoshi Iseki
- Okinawa Heart and Renal Association, Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Mann JFE, Ørsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, Tornøe K, Zinman B, Buse JB. Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377:839-848. [PMID: 28854085 DOI: 10.1056/nejmoa1616011] [Citation(s) in RCA: 763] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown. METHODS We report the prespecified secondary renal outcomes of that randomized, controlled trial in which patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use of time-to-event analyses with an intention-to-treat approach. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. RESULTS A total of 9340 patients underwent randomization, and the median follow-up of the patients was 3.84 years. The renal outcome occurred in fewer participants in the liraglutide group than in the placebo group (268 of 4668 patients vs. 337 of 4672; hazard ratio, 0.78; 95% confidence interval [CI], 0.67 to 0.92; P=0.003). This result was driven primarily by the new onset of persistent macroalbuminuria, which occurred in fewer participants in the liraglutide group than in the placebo group (161 vs. 215 patients; hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P=0.004). The rates of renal adverse events were similar in the liraglutide group and the placebo group (15.1 events and 16.5 events per 1000 patient-years), including the rate of acute kidney injury (7.1 and 6.2 events per 1000 patient-years, respectively). CONCLUSIONS This prespecified secondary analysis shows that, when added to usual care, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .).
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Affiliation(s)
- Johannes F E Mann
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - David D Ørsted
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Kirstine Brown-Frandsen
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Steven P Marso
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Neil R Poulter
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Søren Rasmussen
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Karen Tornøe
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Bernard Zinman
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - John B Buse
- From KfH Kidney Center, Munich, and Friedrich Alexander University of Erlangen, Erlangen - both in Germany (J.F.E.M.); Novo Nordisk, Bagsvaerd, Denmark (D.D.Ø., K.B.-F., S.R., K.T.); University of Texas Southwestern Medical Center, Dallas (S.P.M.); Imperial College London, London (N.R.P.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); and University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
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