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For: Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, 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Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, 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Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024;12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]

For:	Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024;12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]

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Cited by Other Article(s)

van Mil D, Kieneker LM, Heerspink HJL, Gansevoort RT. Screening for chronic kidney disease: change of perspective and novel developments. Curr Opin Nephrol Hypertens 2024;33:583-592. [PMID: 39137037 PMCID: PMC11426989 DOI: 10.1097/mnh.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]

Herrington WG, Staplin N, Agrawal N, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Judge P, Zhu D, Dayanandan R, Arimoto R, Mayne KJ, Ng SYA, Sammons E, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu W, Kadowaki T, Nangaku M, Levin A, Cherney DZI, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Massey D, Brueckmann M, Landray MJ, Baigent C, Haynes R. Long-Term Effects of Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2024:10.1056/NEJMoa2409183. [PMID: 39453837 PMCID: PMC7616743 DOI: 10.1056/nejmoa2409183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2024]

Abstract

BACKGROUND

In the EMPA-KIDNEY trial, empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, had positive cardiorenal effects in patients with chronic kidney disease who were at risk for disease progression. Post-trial follow-up was designed to assess how the effects of empagliflozin would evolve after the discontinuation of the trial drug.

METHODS

In the active trial, patients with chronic kidney disease were randomly assigned to receive either empagliflozin (10 mg once daily) or matching placebo and were followed for a median of 2 years. All the patients had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area or an eGFR of at least 45 but less than 90 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Subsequently, surviving patients who consented were observed for 2 additional years. No trial empagliflozin or placebo was administered during the post-trial period, but local practitioners could prescribe open-label SGLT2 inhibitors, including open-label empagliflozin. The primary composite outcome was kidney disease progression or cardiovascular death as assessed from the start of the active-trial period to the end of the post-trial period.

RESULTS

Of the 6609 patients who had undergone randomization in the active trial, 4891 (74%) were enrolled in the post-trial period. During this period, the use of open-label SGLT2 inhibitors was similar in the two groups (43% in the empagliflozin group and 40% in the placebo group). During the combined active- and post-trial periods, a primary-outcome event occurred in 865 of 3304 patients (26.2%) in the empagliflozin group and in 1001 of 3305 patients (30.3%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.72 to 0.87). During the post-trial period only, the hazard ratio for a primary-outcome event was 0.87 (95% CI, 0.76 to 0.99). During the combined periods, the risk of kidney disease progression was 23.5% in the empagliflozin group and 27.1% in the placebo group; the risk of the composite of death or end-stage kidney disease was 16.9% and 19.6%, respectively; and the risk of cardiovascular death was 3.8% and 4.9%, respectively. There was no effect of empagliflozin on death from noncardiovascular causes (5.3% in both groups).

CONCLUSIONS

In a broad range of patients with chronic kidney disease at risk for progression, empagliflozin continued to have additional cardiorenal benefits for up to 12 months after it was discontinued. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EuDRACT number, 2017-002971-24.).

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Affiliation(s)

William G Herrington From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Natalie Staplin From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Nikita Agrawal From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Christoph Wanner From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Jennifer B Green From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Sibylle J Hauske From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Jonathan R Emberson From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
David Preiss From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Parminder Judge From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Doreen Zhu From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Rejive Dayanandan From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Ryoki Arimoto From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Kaitlin J Mayne From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Sarah Y A Ng From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Emily Sammons From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Michael Hill From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Will Stevens From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Karl Wallendszus From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Susanne Brenner From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Alfred K Cheung From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Zhi-Hong Liu From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Jing Li From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Lai Seong Hooi From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Wen Liu From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Takashi Kadowaki From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Masaomi Nangaku From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Adeera Levin From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
David Z I Cherney From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Aldo P Maggioni From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Roberto Pontremoli From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Rajat Deo From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Shinya Goto From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Xavier Rossello From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Katherine R Tuttle From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Dominik Steubl From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Dan Massey From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Martina Brueckmann From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Martin J Landray From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Colin Baigent From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)
Richard Haynes From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (W.G.H., N.S., N.A., C.W., J.R.E., D.P., P.J., D.Z., R. Dayanandan, R.A., K.J.M., S.Y.A.N., E.S., W.S., K.W., M.H., M.J.L., C.B., R.H.); the University Clinic of Würzburg, Würzburg (C.W., S.B.), Boehringer Ingelheim International (S.J.H., D.S., M.B.), Elderbrook Solutions (D.M.), and the Fifth Department of Medicine, University Medical Center Mannheim (S.J.H.) and the First Department of Medicine, Faculty of Medicine Mannheim (M.B.), University of Heidelberg, Mannheim, and the Department of Nephrology, Hospital Rechts der Isar, Technical University of Munich, Munich (D.S.) - all in Germany; Duke Clinical Research Institute, Durham, NC (J.B.G.); the University of Utah, Salt Lake City (A.K.C.); the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing (Z.-H.L.), and Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing (J.L.) - both in China; Hospital Sultanah Aminah, Johor Bahru, Malaysia (L.S.H., W.L.); the University of Tokyo School of Medicine/Toranomon Hospital (T.K.) and the University of Tokyo School of Medicine (M.N.), Tokyo, and Tokai University School of Medicine, Isehara (S.G.) - all in Japan; the University of British Columbia, Vancouver (A.L.), and the University of Toronto, Toronto (D.Z.I.C.) - both in Canada; Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Genoa (R.P.), and Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.) - both in Italy; the University of Pennsylvania Perelman School of Medicine, Philadelphia (R. Deo); Providence Health Care and University of Washington, Seattle (K.R.T.); and Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands, Universitat Illes Balears, Palma de Mallorca, Spain (X.R.)

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Bellos I, Lagiou P, Benetou V, Marinaki S. Safety and Efficacy of Sodium-Glucose Transport Protein 2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Diabetic Kidney Transplant Recipients: Synthesis of Evidence. J Clin Med 2024;13:6181. [PMID: 39458136 PMCID: PMC11508237 DOI: 10.3390/jcm13206181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/09/2024] [Accepted: 10/14/2024] [Indexed: 10/28/2024] Open

Abstract

Background: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of novel antidiabetics, namely, sodium-glucose transport protein 2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP1-RA), in diabetic kidney transplant recipients. Methods: Medline, Scopus, Web of Science, CENTRAL, and Clinicaltrials.gov were systematically searched from inception until 25 August 2024. Pooled estimates were obtained by applying random-effects models. Results: Overall, 18 studies (17 observational studies and one randomized controlled trial) were included. GLP1-RA were administered to 270 and SGLT2-i to 1003 patients. After GLP1-RA therapy, patients presented significantly lower glycated hemoglobin [mean difference (MD): -0.61%; 95% confidence interval (CI): -0.99; -0.23] and body weight (MD: -3.32 kg; 95% CI: -5.04; -1.59) but a similar estimated glomerular filtration rate (eGFR) and systolic blood pressure. After SGLT2-i therapy, patients had significantly lower glycated hemoglobin (MD: -0.40%, 95% CI: -0.57; -0.23) and body weight (MD: -2.21 kg, 95% CI: -2.74; -1.67), while no difference was noted in eGFR or systolic blood pressure. Preliminary data have shown an association between SGLT2-i use and a reduced risk of cardiovascular events, graft loss, and mortality. Evidence regarding the association between GLP1-RA and SGLT2-i and proteinuria was mixed. No significant effects on calcineurin inhibitor levels were observed. The risk of urinary tract infections was similar among patients treated with SGLT2-i or placebo (odds ratio: 0.84, 95% CI: 0.43; 1.64). Conclusions: Observational data suggest that GLP1-RA and SGLT2-i administration in diabetic kidney transplant recipients may be associated with better glycemic control and reduced body weight, presenting an acceptable safety profile.

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Chang TJ, Lee YC, Wu LC, Chang CH. Albuminuria-based stratification of end-stage kidney disease progression and mortality with sodium-glucose cotransporter 2 inhibitors (SGLT2i): A retrospective cohort study in type 2 diabetes and chronic kidney disease. Pharmacotherapy 2024. [PMID: 39382257 DOI: 10.1002/phar.4615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 09/06/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024]

Abstract

BACKGROUND

Clinical trials have shown the kidney-protective benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i). However, their real-world impact, particularly across varying levels of albuminuria, remains less well understood. This study aimed to evaluate the association of SGLT2i, compared with other oral glucose-lowering drugs, with end-stage kidney disease (ESKD) progression in patients with type 2 diabetes and chronic kidney disease (CKD) stratified by urine albumin-to-creatinine ratio (UACR) levels.

METHODS

Using data from a national database spanning from 2016 to 2021, the study included patients with type 2 diabetes and CKD with estimated glomerular filtration rates (eGFRs) below 60 mL/min/1.73 m2 and who started on SGLT2i or other oral glucose-lowering drugs. Patients were stratified into groups by UACR ≥300 mg/g and <300 mg/g. Propensity score matching was used to minimize confounding, and progression to ESKD was evaluated using competing risks and Cox proportional-hazards models. All-cause mortality was also analyzed.

RESULTS

Following propensity score matching, 18,514 patients in the severely increased albuminuria group (UACR ≥300 mg/g) were tracked, with 2.6% progressing to ESKD over 3 years. In contrast, only 0.3% of the 26,946 patients with UACR <300 mg/g progressed to ESKD. SGLT2i use was associated with a 30% reduction in risk of ESKD progression, compared with the use of other oral glucose-lowering drugs, in the severely increased albuminuria group (hazard ratio[HR]: 0.70, 95% confidence interval [CI]: 0.61-0.80). In the lower albuminuria group, no significant association was evident, though there was a nonsignificant trend toward protection over time. A consistent reduction in mortality risk was observed across all albuminuria levels.

CONCLUSIONS

SGLT2i are associated with a reduction in the progression to ESKD among patients with severely increased albuminuria, with less pronounced effects observed in those with lower albuminuria levels, suggesting variability in renal outcomes based on albuminuria severity. The consistent survival benefit across all albuminuria levels supports the potential utility of SGLT2i in diabetes and CKD treatment strategies, emphasizing the need for more targeted research.

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Czupryniak L, Mosenzon O, Rychlík I, Clodi M, Ebrahimi F, Janez A, Kempler P, Małecki M, Moshkovich E, Prázný M, Sourij H, Tankova T, Timar B. Barriers to early diagnosis of chronic kidney disease and use of sodium-glucose cotransporter-2 inhibitors for renal protection: A comprehensive review and call to action. Diabetes Obes Metab 2024;26:4165-4177. [PMID: 39140231 DOI: 10.1111/dom.15789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/08/2024] [Accepted: 06/26/2024] [Indexed: 08/15/2024]

Abstract

Chronic kidney disease (CKD) affects approximately 13% of people globally, including 20%-48% with type 2 diabetes (T2D), resulting in significant morbidity, mortality, and healthcare costs. There is an urgent need to increase early screening and intervention for CKD. We are experts in diabetology and nephrology in Central Europe and Israel. Herein, we review evidence supporting the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for kidney protection and discuss barriers to early CKD diagnosis and treatment, including in our respective countries. SGLT2 inhibitors exert cardiorenal protective effects, demonstrated in the renal outcomes trials (EMPA-KIDNEY, DAPA-CKD, CREDENCE) of empagliflozin, dapagliflozin, and canagliflozin in patients with CKD. EMPA-KIDNEY demonstrated cardiorenal efficacy across the broadest renal range, regardless of T2D status. Renoprotective evidence also comes from large real-world studies. International guidelines recommend first-line SGLT2 inhibitors for patients with T2D and estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m2, and that glucagon-like peptide-1 receptor agonists may also be administered if required for additional glucose control. Although these guidelines recommend at least annual eGFR and urine albumin-to-creatinine ratio screening for patients with T2D, observational studies suggest that only half are screened. Diagnosis is hampered by asymptomatic early CKD and under-recognition among patients with T2D and clinicians, including limited knowledge/use of guidelines and resources. Based on our experience and on the literature, we recommend robust screening programmes, potentially with albuminuria self-testing, and SGLT2 inhibitor reimbursement at general practitioner (GP) and specialist levels. High-tech tools (artificial intelligence, smartphone apps, etc.) are providing exciting opportunities to identify high-risk individuals, self-screen, detect abnormalities in images, and assist with prescribing and treatment adherence. Better education is also needed, alongside provision of concise guidelines, enabling GPs to identify who would benefit from early initiation of renoprotective therapy; although, regardless of current renal function, cardiorenal protection is provided by SGLT2 inhibitor therapy.

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Affiliation(s)

Leszek Czupryniak Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
Ofri Mosenzon Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Centre, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel Regeneron Pharmaceuticals, Tarrytown, New York, USA
Ivan Rychlík Department of Internal Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic University Hospital Královské Vinohrady, Prague, Czech Republic
Martin Clodi Hospital of Internal Medicine Brüder Linz, Linz, Austria Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
Fahim Ebrahimi University Digestive Health Care Centre Basel-Clarunis, Basel, Switzerland Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Andrej Janez Department of Endocrinology, Diabetes and Metabolic Diseases, Medical Centre, University of Ljubljana Medical Faculty, Ljubljana, Slovenia
Peter Kempler Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
Maciej Małecki Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
Evgeny Moshkovich Diabetes and Endocrinology Clinic, Clalit Medical Services, Ramat Gan, Israel
Martin Prázný 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
Harald Sourij Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
Tsvetalina Tankova Department of Endocrinology, Medical University - Sofia, Sofia, Bulgaria
Bogdan Timar Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania Centre for Molecular Research in Nephrology and Vascular Disease, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania Diabetes Clinic, "Pius Brinzeu" Emergency Hospital, Timisoara, Romania

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Bakker WM, Gansevoort RT, Yang C, Chertow GM, Heerspink HJ, Vart P. Sodium-Glucose Cotransporter 2 Inhibitors in Older Patients with CKD. J Am Soc Nephrol 2024;35:1446-1449. [PMID: 39133046 PMCID: PMC11452167 DOI: 10.1681/asn.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open

Kronbichler A, Anders HJ, Frangou E, Mirioglu S, Odler B, Quintana LF, Soler Romeo MJ, Bruchfeld A. Correspondence on 'EULAR recommendations for the management of systemic lupus erythematosus: 2023 update' by Fanouriakis et al. Ann Rheum Dis 2024;83:e18. [PMID: 38580397 DOI: 10.1136/ard-2024-225563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 04/07/2024]

Mayne KJ, Sardell RJ, Staplin N, Judge PK, Zhu D, Sammons E, Cherney DZI, Green JB, Levin A, Pontremoli R, Hauske SJ, Emberson J, Preiss D, Landray MJ, Baigent C, Wanner C, Haynes R, Herrington WG. Empagliflozin lowers serum uric acid in chronic kidney disease: exploratory analyses from the EMPA-KIDNEY trial. Nephrol Dial Transplant 2024:gfae203. [PMID: 39277784 PMCID: PMC7616479 DOI: 10.1093/ndt/gfae203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024] Open

Abstract

BACKGROUND AND HYPOTHESIS

Hyperuricaemia and gout are common in chronic kidney disease (CKD). We aimed to assess the effects of sodium-glucose co-transporter-2 (SGLT2) inhibition on uric acid (urate) and gout in patients with CKD.

METHODS

The EMPA-KIDNEY trial randomised 6609 patients with CKD (estimated glomerular filtration rate [eGFR] ≥20 and <90 mL/min/1.73m2) to receive either empagliflozin 10 mg daily or matching placebo over a median of two years follow-up. Serum uric acid was measured at randomisation then 2 and 18 months of follow-up and the effects of empagliflozin were analysed using a pre-specified mixed model repeated measures approach. Participant-reported gout events were analysed in Cox regression models (first events) with the Andersen-Gill extension (total events). A post-hoc composite outcome included new initiation of uric acid lowering therapy or colchicine. EMPA-KIDNEY primary and kidney disease progression outcomes were also assessed in subgroups of baseline serum uric acid.

RESULTS

Baseline mean ± SD serum uric acid concentration was 431±114 µmol/L. Allocation to empagliflozin resulted in a study-average between-group difference in serum uric acid of -25.6 (95%CI -30.3,-21.0) µmol/L with larger effects in those with higher eGFR (trend P < 0.001) and without diabetes (heterogeneity P < 0.001). Compared to placebo, empagliflozin did not significantly reduce first or total gout events (HR 0.87, 95%CI 0.74-1.02 for the 595 first events, and 0.86, 0.72-1.03 for the 869 total events) with similar hazard ratios for the post-hoc composite and across subgroups, including by diabetes and eGFR. The effect of empagliflozin on the primary outcome and kidney disease progression outcomes were similar irrespective of baseline level of uric acid.

CONCLUSION

SGLT2 inhibition reduces serum uric acid in patients with CKD with larger effects at higher eGFR and in the absence of diabetes. However, the effect on uric acid is modest and did not translate into reduced risk of gout in EMPA-KIDNEY.

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Affiliation(s)

Kaitlin J Mayne Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
Rebecca J Sardell Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
Natalie Staplin Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
Parminder K Judge Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Doreen Zhu Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Emily Sammons Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
David Z I Cherney University of Toronto, Toronto, Canada
Jennifer B Green Duke Clinical Research Institute, Durham, NC, USA
Adeera Levin University of British Columbia, Vancouver, Canada
Roberto Pontremoli Università degli Studi and IRCCS Ospedale Policlinico San Martino di Genova, Italy
Sibylle J Hauske Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany & Vth Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
Jonathan Emberson Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
David Preiss Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
Martin J Landray Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
Colin Baigent Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
Christoph Wanner Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
Richard Haynes Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
William G Herrington Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

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Liu G. Assessment of the effect of the SLC5A2 gene on eGFR: a Mendelian randomization study of drug targets for the nephroprotective effect of sodium-glucose cotransporter protein 2 inhibition. Front Endocrinol (Lausanne) 2024;15:1418575. [PMID: 39268232 PMCID: PMC11390543 DOI: 10.3389/fendo.2024.1418575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/14/2024] [Indexed: 09/15/2024] Open

Abstract

Aim

Sodium-glucose cotransporter protein 2 (SGLT2) inhibitors have been shown to have renoprotective effects in clinical studies. For further validation in terms of genetic variation, drug-targeted Mendelian randomization (MR) was used to investigate the causal role of SGLT2 inhibition on eGFR effects.

Methods

Genetic variants representing SGLT2 inhibition were selected as instrumental variables. Drug target Mendelian randomization analysis was used to investigate the relationship between SGLT2 inhibitors and eGFR. The IVW method was used as the primary analysis method. As a sensitivity analysis, GWAS pooled data from another CKDGen consortium was used to validate the findings.

Results

MR results showed that hemoglobin A1c (HbA1c) levels, regulated by the SLC5A2 gene, were negatively correlated with eGFR (IVW β -0.038, 95% CI -0.061 to -0.015, P = 0.001 for multi-ancestry populations; IVW β -0.053, 95% CI -0.077 to -0.028, P = 2.45E-05 for populations of European ancestry). This suggests that a 1-SD increase in HbA1c levels, regulated by the SLC5A2 gene, is associated with decreased eGFR. Mimicking pharmacological inhibition by lowering HbA1c per 1-SD unit through SGLT2 inhibition reduces the risk of eGFR decline, demonstrating a renoprotective effect of SGLT2 inhibitors. HbA1c, regulated by the SLC5A2 gene, was negatively correlated with eGFR in both validation datasets (IVW β -0.027, 95% CI -0.046 to -0.007, P=0.007 for multi-ancestry populations, and IVW β -0.031, 95% CI -0.050 to -0.011, P=0.002 for populations of European origin).

Conclusions

The results of this study indicate that the SLC5A2 gene is causally associated with eGFR. Inhibition of SLC5A2 gene expression was linked to higher eGFR. The renoprotective mechanism of SGLT2 inhibitors was verified from the perspective of genetic variation.

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Ma J, Yiu WH, Tang SCW. Complement anaphylatoxins: Potential therapeutic target for diabetic kidney disease. Diabet Med 2024:e15427. [PMID: 39189098 DOI: 10.1111/dme.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]

Apperloo EM, Neuen BL, Fletcher RA, Jongs N, Anker SD, Bhatt DL, Butler J, Cherney DZI, Herrington WG, Inzucchi SE, Jardine MJ, Liu CC, Mahaffey KW, McGuire DK, McMurray JJV, Neal B, Packer M, Perkovic V, Sabatine MS, Solomon SD, Staplin N, Szarek M, Vaduganathan M, Wanner C, Wheeler DC, Wiviott SD, Zannad F, Heerspink HJL. Efficacy and safety of SGLT2 inhibitors with and without glucagon-like peptide 1 receptor agonists: a SMART-C collaborative meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol 2024;12:545-557. [PMID: 38991584 DOI: 10.1016/s2213-8587(24)00155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 07/13/2024]

Abstract

BACKGROUND

SGLT2 inhibitors and GLP-1 receptor agonists both improve cardiovascular and kidney outcomes in patients with type 2 diabetes. We sought to evaluate whether the benefits of SGLT2 inhibitors are consistent in patients receiving and not receiving GLP-1 receptor agonists.

METHODS

We conducted a collaborative meta-analysis of trials included in the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium, restricted to participants with diabetes. Treatment effects from individual trials were obtained from Cox regression models and pooled using inverse variance weighted meta-analysis. The two main cardiovascular outcomes assessed included major adverse cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), and hospitalisation for heart failure or cardiovascular death. The main kidney outcomes assessed were chronic kidney disease progression (≥40% decline in estimated glomerular filtration rate [eGFR], kidney failure [eGFR <15 mL/min/1·73 m2, chronic dialysis, or kidney transplantation], or death due to kidney failure), and the rate of change in eGFR over time. Safety outcomes were also assessed.

FINDINGS

Across 12 randomised, double-blind, placebo-controlled trials, 3065 (4·2%) of 73 238 participants with diabetes were using GLP-1 receptor agonists at baseline. SGLT2 inhibitors reduced the risk of major adverse cardiovascular events in participants both receiving and not receiving GLP-1 receptor agonists (hazard ratio [HR] 0·81, 95% CI 0·63-1·03 vs 0·90, 0·86-0·94; p-heterogeneity=0·31). Effects on hospitalisation for heart failure or cardiovascular death (0·76, 0·57-1·01 vs 0·78, 0·74-0·82; p-heterogeneity=0·90) and chronic kidney disease progression (0·65, 0·46-0·94 vs 0·67, 0·62-0·72; p-heterogeneity=0·81) were also consistent regardless of GLP-1 receptor agonist use, as was the effect on the chronic rate of change in eGFR over time (heterogeneity=0·92). Fewer serious adverse events occurred with SGLT2 inhibitors compared with placebo, irrespective of GLP-1 receptor agonist use (relative risk 0·87, 95% CI 0·79-0·96 vs 0·91, 0·89-0·93; p-heterogeneity=0·41).

INTERPRETATION

The effects of SGLT2 inhibitors on cardiovascular and kidney outcomes are consistent regardless of the background use of GLP-1 receptor agonists. These findings suggest independent effects of these evidence-based therapies and support clinical practice guidelines recommending the use of these agents in combination to improve cardiovascular and kidney metabolic outcomes.

FUNDING

National Health and Medical Research Council of Australia and the Ramaciotti Foundation.

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Affiliation(s)

Ellen M Apperloo Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
Brendon L Neuen The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
Robert A Fletcher The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Niels Jongs Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
Stefan D Anker Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, German Center for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
Deepak L Bhatt Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Javed Butler Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
David Z I Cherney Department of Medicine, Division of Nephrology, Toronto General Hospital, ON, Canada
William G Herrington Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Silvio E Inzucchi Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
Meg J Jardine The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
Chih-Chin Liu Merck, Rahway, NJ, USA
Kenneth W Mahaffey Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
Darren K McGuire University of Texas Southwestern Medical Center and Parkland Health, Dallas, TX, USA
John J V McMurray British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
Bruce Neal The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Epidemiology and Biostatistics, Imperial College London, London, UK
Milton Packer Baylor University Medical Center, Dallas TX, USA; Imperial College, London, UK
Vlado Perkovic The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Marc S Sabatine TIMI Study Group, Boston, MA, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Scott D Solomon Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Natalie Staplin Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Michael Szarek Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA; Colorado Prevention Center Clinical Research, Aurora, CO, USA; State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
Muthiah Vaduganathan Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Christoph Wanner Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Centre, University Hospital, Würzburg, Germany
David C Wheeler Department of Renal Medicine, University College London, London, UK
Stephen D Wiviott TIMI Study Group, Boston, MA, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Faiez Zannad Université de Lorraine, Inserm, Center d'Investigations Cliniques, Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
Hiddo J L Heerspink Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.

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Herrington WG, Haynes R. Diabetic Kidney Disease - Semaglutide Flows into the Mainstream. N Engl J Med 2024;391:178-179. [PMID: 38986062 DOI: 10.1056/nejme2406408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]

Chatur S, Neuen BL, Claggett BL, Beldhuis IE, Mc Causland FR, Desai AS, Rouleau JL, Zile MR, Lefkowitz MP, Packer M, McMurray JJV, Solomon SD, Vaduganathan M. Effects of Sacubitril/Valsartan Across the Spectrum of Renal Impairment in Patients With Heart Failure. J Am Coll Cardiol 2024;83:2148-2159. [PMID: 38588927 DOI: 10.1016/j.jacc.2024.03.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]

Abstract

BACKGROUND

The Kidney Disease Improving Global Outcomes (KDIGO) classification integrates both estimated glomerular filtration rate and urine-albumin-creatinine ratio to stratify risk more comprehensively in patients with chronic kidney disease. There are limited data assessing whether this classification system is associated with prognosis and treatment response in heart failure populations.

OBJECTIVES

The aim of this study was to evaluate the relative treatment effects of sacubitril/valsartan across the KDIGO risk categories in patients with HFrEF.

METHODS

PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) was a global randomized controlled trial evaluating sacubitril/valsartan vs enalapril in patients with heart failure with reduced ejection fraction (HFrEF). Patients were classified according to low, moderate, and high/very high KDIGO risk. Treatment responses were assessed according to baseline KDIGO risk. The primary outcome was a composite of cardiovascular (CV) death or heart failure hospitalization. A renal composite outcome was defined as sustained decline in estimated glomerular filtration rate by ≥40% or end-stage kidney disease.

RESULTS

Among 1,910 (23% of total) participants with available data, 42%, 32%, and 26% were classified as low, moderate, and high/very high KDIGO risk, respectively. Patients in the highest KDIGO risk categories experienced the highest rates of the primary composite outcome (7.6 per 100 person-years [95% CI: 6.5-9.0 per 100 person-years], 9.4 per 100 person-years [95% CI: 7.9-11.2 per 100 person-years], and 14.9 per 100 person-years [95% CI: 12.7-17.6 per 100 person-years]; P < 0.001). Sacubitril/valsartan had a similar safety profile and demonstrated consistent effects on the risk of both the primary outcome (PInteraction = 0.31) and the renal composite outcome (PInteraction = 0.50) across the spectrum of KDIGO risk.

CONCLUSIONS

One in 4 patients with HFrEF were classified as at least high KDIGO kidney risk; these individuals faced concordantly the highest risks of CV events. Sacubitril/valsartan exhibited consistent CV and kidney protective benefits as well as safety across the spectrum of baseline kidney risk. These data further support initiation of sacubitril/valsartan in HFrEF across a broad range of kidney risk. (This Study Will Evaluate the Efficacy and Safety of LCZ696 Compared to Enalapril on Morbidity and Mortality of Patients With Chronic Heart Failure [PARADIGM-HF]; NCT01035255).

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Helvaci O, Yasar E, Helvaci B. Challenging the Restrictive Approach: Reconsidering Sodium-Glucose Transport Protein 2 Inhibitor Use in CKD. Kidney Int Rep 2024;9:1935. [PMID: 38899178 PMCID: PMC11184246 DOI: 10.1016/j.ekir.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024] Open

Tarun T, Davis OM, Ghanta SN, Jain N. Response to [Challenging the Restrictive Approach: Reconsidering SGLT-2 Inhibitor Use in CKD]. Kidney Int Rep 2024;9:1936. [PMID: 38899220 PMCID: PMC11184256 DOI: 10.1016/j.ekir.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 06/21/2024] Open

Galceran JM. Is proteinuria an important fact concerning the nephroprotective effect of renin-angiotensin system inhibitors? HIPERTENSION Y RIESGO VASCULAR 2024;41:75-77. [PMID: 38508876 DOI: 10.1016/j.hipert.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]

Mone P, Guerra G, Lombardi A, Illario M, Pansini A, Marro A, Frullone S, Taurino A, Sorriento D, Verri V, Iaccarino G, Santulli G. Effects of SGLT2 inhibition via empagliflozin on cognitive and physical impairment in frail diabetic elders with chronic kidney disease. Pharmacol Res 2024;200:107055. [PMID: 38176528 PMCID: PMC11379121 DOI: 10.1016/j.phrs.2023.107055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]