Key result
Using individual albuminuria exposure during the first 12 months improved renal risk prediction compared to the initial Month 3 change (ROC AUC 0.78 vs 0.68; P < 0.0001).
Why the study?
Does incorporating individual albuminuria exposure over 12 months improve renal outcome prediction compared to initial 3-month change in patients with diabetes and nephropathy on ARB therapy?
Cohort
Yes
Does incorporating individual albuminuria exposure over 12 months improve renal outcome prediction compared to initial 3-month change in patients with diabetes and nephropathy on ARB therapy?
Absolute Event Rate: 0.78% vs 0.68%
p-value: p=< 0.0001
Incorporating multiple albuminuria measurements over 12 months improves the prediction of renal outcomes in diabetic nephropathy patients on ARB therapy compared to relying solely on the initial 3-month response.
May refine renal risk stratification using 12-month albuminuria trajectories in CKD; extends single-timepoint models but leaves open prospective validation.
BACKGROUND: Albuminuria reduction due to angiotensin receptor blockers (ARBs) predicts subsequent renoprotection. Relating the initial albuminuria reduction to subsequent renoprotection assumes that the initial ARB-induced albuminuria reduction remains stable during follow-up. The aim of this study was to assess individual albuminuria fluctuations after the initial ARB response and to determine whether taking individual albuminuria fluctuations into account improves renal outcome prediction. METHODS: Patients with diabetes and nephropathy treated with losartan or irbesartan in the RENAAL and IDNT trials were included. Patients with >30% reduction in albuminuria 3 months after ARB initiation were stratified by the subsequent change in albuminuria until Month 12 in enhanced responders (>50% albuminuria reduction), sustained responders (between 20 and 50% reduction), and response escapers (<20% reduction). Predictive performance of the individual albuminuria exposure until Month 3 was compared with the exposure over the first 12 months using receiver operating characteristics (ROC) curves. RESULTS: Following ARB initiation, 388 (36.3%) patients showed an >30% reduction in albuminuria. Among these patients, the albuminuria level further decreased in 174 (44.8%), remained stable in 123 (31.7%), and increased in 91 (23.5%) patients. Similar albuminuria fluctuations were observed in patients with <30% albuminuria reduction. Renal risk prediction improved when using the albuminuria exposure during the first 12 months versus the initial Month 3 change [ROC difference: 0.78 (95% CI 0.75-0.82) versus 0.68 (0.64-0.72); P < 0.0001]. CONCLUSIONS: Following the initial response to ARBs, a large within-patient albuminuria variability is observed. Hence, incorporating multiple albuminuria measurements over time in risk algorithms may be more appropriate to monitor treatment effects and quantify renal risk.
No takes yet. Share an insight, caveat, or question.
Kröpelin et al. (2016) conducted a cohort in Diabetes and nephropathy. Albuminuria exposure during the first 12 months vs. Initial Month 3 change in albuminuria was evaluated on Renal risk prediction (ROC AUC) (p=< 0.0001). Using individual albuminuria exposure during the first 12 months improved renal risk prediction compared to the initial Month 3 change (ROC AUC 0.78 vs 0.68; P < 0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: