Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial
Persson F, Bain SC, Mosenzon O, Heerspink HJL, Mann J, Pratley R, Raz I, Idorn T, Rasmussen S, Von Scholten BJ, Rossing P (2021)
Publication Type: Journal article
Publication year: 2021
Journal
Book Volume: 44
Pages Range: 1020-1026
Journal Issue: 4
DOI: 10.2337/dc20-1622
Abstract
OBJECTIVE A post hoc analysis to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events. RESEARCH DESIGN AND METHODS LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5-5 years in 9,340 participants with type 2 diabetes and high cardiovascular risk. We calculated change in urinary albumin-to-creatinine ratio (UACR) from baseline to 1 year in participants with >30% reduction (n = 2,928), 30-0% reduction (n = 1,218), or any increase in UACR (n = 4,124), irrespective of treatment. Using Cox regression, risks of major adverse cardiovascular events (MACE) and a composite nephropathy outcome (from 1 year to end of trial in subgroups by baseline UACR [<30 mg/g, 30-300 mg/g, or >= 300 mg/g]) were assessed. The analysis was adjusted for treatment allocation alone as a fixed factor and for baseline variables associated with cardiovascular and renal outcomes. RESULTS For MACE, hazard ratios (HRs) for those with >30% and 30-0% UACR reduction were 0.82 (95% CI 0.71, 0.94; P = 0.006) and 0.99 (0.82, 1.19; P = 0.912), respectively, compared with any increase in UACR (reference). For the composite nephropathy outcome, respective HRs were 0.67 (0.49, 0.93; P = 0.02) and 0.97 (0.66, 1.43; P = 0.881). Results were independent of baseline UACR and consistent in both treatment groups. After adjustment, HRs were significant and consistent in >30% reduction subgroups with baseline micro- or macroalbuminuria. CONCLUSIONS A reduction in albuminuria during the 1st year was associated with fewer cardiovascular and renal outcomes, independent of treatment. Albuminuria monitoring remains an important part of diabetes care, with great unused potential.
Involved external institutions
Novo Nordisk A/S
Denmark (DK)
Hebrew University of Jerusalem
Israel (IL)
AdventHealth
United States (USA) (US)
Swansea University
United Kingdom (GB)
University of Groningen / Rijksuniversiteit Groningen
Netherlands (NL)
Steno Diabetes Center
Denmark (DK)
Denmark (DK)
Hebrew University of Jerusalem
Israel (IL)
AdventHealth
United States (USA) (US)
Swansea University
United Kingdom (GB)
University of Groningen / Rijksuniversiteit Groningen
Netherlands (NL)
Steno Diabetes Center
Denmark (DK)
How to cite
APA:
Persson, F., Bain, S.C., Mosenzon, O., Heerspink, H.J.L., Mann, J., Pratley, R.,... Rossing, P. (2021). Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial. Diabetes Care, 44(4), 1020-1026. https://doi.org/10.2337/dc20-1622
MLA:
Persson, Frederik, et al. "Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial." Diabetes Care 44.4 (2021): 1020-1026.
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