1
|
Reijrink M, de Boer SA, Te Velde-Keyzer CA, Sluiter JKE, Pol RA, Heerspink HJL, Greuter MJW, Hillebrands JL, Mulder DJ, Slart RHJA. [ 18F]FDG and [ 18F]NaF as PET markers of systemic atherosclerosis progression: A longitudinal descriptive imaging study in patients with type 2 diabetes mellitus. J Nucl Cardiol 2022; 29:1702-1709. [PMID: 34519008 PMCID: PMC9345832 DOI: 10.1007/s12350-021-02781-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While [18F]-fluordeoxyglucose ([18F]FDG) uptake is associated with arterial inflammation, [18F]-sodium fluoride ([18F]NaF) is a marker for arterial micro-calcification. We aimed to investigate the prospective correlation between both PET markers over time and whether they are prospectively ([18F]FDG) and retrospectively ([18F]NaF) related to progression of systemic arterial disease in a longitudinal study in patients with type 2 diabetes mellitus (T2DM). METHODS Baseline [18F]FDG PET/Low Dose (LD) Computed Tomography (CT) scans of ten patients with early T2DM without cardiovascular history (70% men, median age 63 years) were compared with five-year follow-up [18F]NaF/LDCT scans. Systemic activity was expressed as mean target-to-background ratio (meanTBR) by dividing the maximal standardized uptake value (SUVmax) of ten arteries by SUVmean of the caval vein. CT-assessed macro-calcifications were scored visually and expressed as calcified plaque (CP) score. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). Five-year changes were expressed absolutely with delta (Δ) and relatively with %change. RESULTS Baseline meanTBR[18F]FDG was strongly correlated with five-year follow-up meanTBR[18F]NaF (r = 0.709, P = .022). meanTBR[18F]NaF correlated positively with ΔCPscore, CPscore at baseline, and follow-up (r = 0.845, P = .002 and r = 0.855, P = .002, respectively), but not with %change in CPscore and PWV. CONCLUSION This proof-of-concept study demonstrated that systemic arterial inflammation is an important pathogenetic factor in systemic arterial micro-calcification development.
Collapse
Affiliation(s)
- M Reijrink
- Div. Vascular Medicine, Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Div. Pathology, Dept. Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S A de Boer
- Div. Vascular Medicine, Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C A Te Velde-Keyzer
- Div. Nephrology, Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J K E Sluiter
- Div. Vascular Medicine, Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R A Pol
- Department of Vascular and Transplant Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H J L Heerspink
- Dept. Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J W Greuter
- Dept. of Radiology, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - J L Hillebrands
- Div. Pathology, Dept. Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J Mulder
- Div. Vascular Medicine, Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R H J A Slart
- Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
- Dept. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
2
|
Neuen BL, Oshima M, Perkovic V, Arnott C, Bakris G, Cannon CP, Charytan DM, Jardine M, Levin A, Neal B, Pollock C, Wheeler DC, Mahaffey KW, Heerspink HJL. Effects of canagliflozin on hyperkalaemia and serum potassium in people with diabetes and chronic kidney disease: insights from the CREDENCE trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin aldosterone system (RAAS), particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain.
Purpose
We sought to assess the effect of canagliflozin on hyperkalaemia and other potassium-related outcomes in people with T2DM and CKD by conducting a post-hoc analysis of the CREDENCE trial.
Methods
The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post-hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and <3.5 mmol/L, respectively) and change in serum potassium.
Results
At baseline the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin angiotensin system blockade. Canagliflozin reduced the risk of investigator-reported hyperkalaemia or initiation of potassium binders (HR 0.78, 95% CI 0.64–0.95, p=0.014; Figure 1). The incidence of laboratory-determined hyperkalaemia was similarly reduced (HR 0.77, 95% CI 0.61–0.98, p=0.031; Figure 2); the risk of hypokalaemia (HR 0.92, 95% CI 0.71–1.20, p=0.53) was not increased. Mean serum potassium over time with canagliflozin was similar to that of placebo.
Conclusion
Among patients treated with RAAS inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Collapse
Affiliation(s)
- B L Neuen
- The George Institute for Global Health, Sydney, Australia
| | - M Oshima
- The George Institute for Global Health, Sydney, Australia
| | - V Perkovic
- University of New South Wales Sydney, Sydney, Australia
| | - C Arnott
- The George Institute for Global Health, Sydney, Australia
| | - G Bakris
- University of Chicago Medicine, Chicago, United States of America
| | - C P Cannon
- Harvard Medical School, Boston, United States of America
| | - D M Charytan
- New York University Langone Medical Center, New York, United States of America
| | - M Jardine
- University of Sydney, Sydney, Australia
| | - A Levin
- University of British Columbia, Vancouver, Canada
| | - B Neal
- The George Institute for Global Health, Sydney, Australia
| | - C Pollock
- University of Sydney, Sydney, Australia
| | - D C Wheeler
- University College London, London, United Kingdom
| | - K W Mahaffey
- Stanford University Medical Center, Stanford, United States of America
| | - H J L Heerspink
- University Medical Center Groningen, Groningen, Netherlands (The)
| |
Collapse
|
3
|
Zelniker TA, Raz I, Mosenzon O, Dwyer JP, Heerspink HJL, Cahn A, Im K, Bhatt DL, Leiter LA, McGuire DK, Wilding JPH, Gause-Nilsson IAM, Langkilde AM, Sabatine MS, Wiviott SD. 192Effect of dapagliflozin on cardiovascular outcomes in patients with type 2 diabetes according to baseline renal function and albuminuria status: Insights from DECLARE-TIMI 58. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Renal dysfunction including both reduced estimated glomerular filtration rate (eGFR) and the presence of albuminuria have each been shown to predict cardiovascular (CV) outcomes. Sodium glucose co-transporter 2 inhibitors (SGLT2i), which promote glucose excretion in the kidneys, reduce CV events and hospitalizations for heart failure (HHF) in patients with type 2 diabetes mellitus (T2DM).
Purpose
To analyze the CV efficacy of dapagliflozin according to baseline renal function and albuminuria status in DECLARE-TIMI 58.
Methods
The DECLARE-TIMI 58 trial compared dapagliflozin vs. placebo in 17,160 patients with T2DM and a creatinine clearance >60 ml/min/1.73m2 at enrollment. The dual primary endpoints were CV death/HHF and MACE (MI, stroke, CV death). We categorized patients according baseline eGFR [<60 vs. ≥60 ml/min/1.73m2 according to the CKD-EPI formula] and urinary albumin:creatinine ratio (UACR) [<30 vs. ≥30 mg/g]. Cox regression models with interaction testing were applied. The Gail-Simon test was used to test for interaction of the absolute risk differences.
Results
In total, 5198 (30.3%) patients had albuminuria (UACR 30–300: n=4029; UACR >300: n=1169) and 1265 (7.4%) had an eGFR <60 ml/min/1.73m2. Accordingly, 10958 (63.9%) patients had no manifestation of CKD, 5367 (31.3%) had either an eGFR <60 ml/min/1.73m2 or albuminuria, and 548 (3.2%) patients had both manifestations. Patients with more abnormal markers had higher event rates for CV death/HHF (KM event rates at 4 years of 3.9%, 8.3%, 17.4%) and MACE (7.5%, 11.7%, and 18.9%) for no, 1, or 2 markers of CKD, respectively. The relative risk reductions for CV death/HHF and MACE were generally consistent across the subgroups (both P-interaction >0.29), though numerically greatest (42%) in patients with reduced eGFR and albuminuria. However, the absolute risk difference increased substantially in patients with greater kidney damage (absolute risk difference of CV death/HHF: −0.5%, −1.0%, and −8.3%, respectively; P-INT for ARD 0.002; Figure). See figure for MACE and component outcomes.
Conclusions
Patients with baseline renal disease had higher rates of adverse CV outcomes. Dapagliflozin reduced events with generally consistent relative risk, but reduced the absolute risk of CVD/HHF by the greatest amount in patients with kidney disease evidenced by both reduced eGFR and albuminuria.
Acknowledgement/Funding
AstraZeneca, Deutsche Forschungsgemeinschaft (ZE 1109/1-1)
Collapse
Affiliation(s)
- T A Zelniker
- TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| | - I Raz
- Hadassah University Medical Center, Jerusalem, Israel
| | - O Mosenzon
- Hadassah University Medical Center, Jerusalem, Israel
| | - J P Dwyer
- Vanderbilt University, Nashville, United States of America
| | - H J L Heerspink
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - A Cahn
- Hadassah University Medical Center, Jerusalem, Israel
| | - K Im
- TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| | - D L Bhatt
- TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| | | | - D K McGuire
- University of Texas Southwestern Medical School, Dallas, United States of America
| | | | | | | | - M S Sabatine
- TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| | - S D Wiviott
- TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| |
Collapse
|
4
|
Heerspink HJL, Johnsson E, Gause-Nilsson I, Cain VA, Sjöström CD. Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin-angiotensin blockers. Diabetes Obes Metab 2016; 18:590-7. [PMID: 26936519 PMCID: PMC4850750 DOI: 10.1111/dom.12654] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 01/23/2016] [Accepted: 02/27/2016] [Indexed: 01/10/2023]
Abstract
AIMS To characterize the effect of dapagliflozin on albuminuria and estimated glomerular filtration rate (eGFR) and to determine whether effects on albuminuria were mediated through changes in glycated haemoblogin (HbA1c), systolic blood pressure (SBP), body weight or eGFR. METHODS We conducted a post hoc analysis of data pooled from two phase III clinical trials in hypertensive patients with type 2 diabetes (T2DM) on stable angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, randomly assigned to dapagliflozin 10 mg/day or matched placebo. This analysis included only patients with microalbuminuria or macroalbuminuria at baseline. RESULTS Patients were randomized to receive dapagliflozin 10 mg (n = 167) or placebo (n = 189). Dapagliflozin resulted in greater 12-week reductions in albuminuria compared with placebo: -33.2% [95% confidence interval (CI) -45.4, -18.2]. The reduction in albuminuria was also present after adjusting for age, sex and changes in HbA1c, SBP, body weight and eGFR: -23.5% (95% CI -37.6, -6.3). There was a decrease in eGFR with dapagliflozin versus placebo that was readily reversed 1 week after last dose. No serious renal-related adverse events were observed in any group. CONCLUSIONS Dapagliflozin was effective in lowering albuminuria in patients with T2DM and hypertension using renin-angiotensin system blockade therapy. Reductions in albuminuria were still present after adjusting for changes in HbA1c, SBP, body weight and eGFR. Dapagliflozin-induced improvements in glycaemic control and reductions in SBP, coupled with other potentially beneficial renal effects, may lead to a reduced long-term renal and cardiovascular risk.
Collapse
Affiliation(s)
- H J L Heerspink
- University of Groningen, University Medical Center, Groningen, The Netherlands
| | - E Johnsson
- AstraZeneca, Gothenburg, Mölndal, Sweden
| | | | - V A Cain
- AstraZeneca, Wilmington, DE, USA
| | | |
Collapse
|
5
|
Heerspink HJL, Ninomiya T, Persson F, Brenner BM, Brunel P, Chaturvedi N, Desai AS, Haffner SM, Mcmurray JJV, Solomon SD, Pfeffer MA, Parving HH, de Zeeuw D. Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial. Diabetes Obes Metab 2016; 18:169-77. [PMID: 26511599 DOI: 10.1111/dom.12600] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/24/2015] [Accepted: 10/24/2015] [Indexed: 01/23/2023]
Abstract
AIMS To investigate whether the degree of albuminuria reduction observed in the ALTITUDE trial is associated with renal and cardiovascular protection, and secondly, whether the reduction in albuminuria was too small to afford clinical benefit. METHODS In a post hoc analysis of the ALTITUDE trial in 8561 patients with type 2 diabetes and chronic kidney disease or cardiovascular disease we examined the effect of albuminuria changes at 6 months on renal and cardiovascular outcomes using Cox proportional hazard regression. RESULTS The median change in albuminuria in the first 6 months in the aliskiren arm of the trial was -12% (25th to 75th percentile: -48.7_to_ +41.9%) and 0.0% (25th to 75th percentile: -40.2_to_55%) in the placebo arm. Changes in albuminuria in the first 6 months were linearly associated with renal and cardiovascular endpoints: a >30% reduction in albuminuria in the first 6 months was associated with a 62% reduction in renal risk and a 25% reduction in cardiovascular risk compared with an increase in albuminuria. The association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar in the two treatment groups (p for interaction >0.1 for both endpoints). CONCLUSIONS The addition of aliskiren to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy resulted in albuminuria changes that were associated with renal and cardiovascular risk changes. This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm.
Collapse
Affiliation(s)
- H J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Ninomiya
- Division of Research Management, Center for Cohort Studies Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - F Persson
- Steno Diabetes Centre, Gentofte, Denmark
| | - B M Brenner
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Brunel
- Novartis Pharma AB, Global Medical Affairs, Basel, Switzerland
| | - N Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - A S Desai
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - S M Haffner
- Department of Medicine and Clinical Epidemiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - J J V Mcmurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H-H Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|