Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial
Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creati...
| المؤلفون الرئيسيون: | , , , , , , , , , , , , , , , , |
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| التنسيق: | Journal article |
| منشور في: |
American Heart Association
2018
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| _version_ | 1826285294440153088 |
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| author | Ohkuma, T Jun, M Rodgers, A Cooper, M Glasziou, P Hamet, P Harrap, S Mancia, G Marre, M Neal, B Perkovic, V Poulter, N Williams, B Zoungas, S Chalmers, J Woodward, M on behalf of the ADVANCE Collaborative Group |
| author_facet | Ohkuma, T Jun, M Rodgers, A Cooper, M Glasziou, P Hamet, P Harrap, S Mancia, G Marre, M Neal, B Perkovic, V Poulter, N Williams, B Zoungas, S Chalmers, J Woodward, M on behalf of the ADVANCE Collaborative Group |
| author_sort | Ohkuma, T |
| collection | OXFORD |
| description | Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creatinine are unclear. In the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), 11 140 diabetes mellitus patients were randomly assigned to perindopril-indapamide or placebo after a 6-week active run-in period. The current study included 11 066 participants with 2 serum creatinine measurements recorded before and during the active run-in period (3 weeks apart). Acute increase in creatinine was determined using these 2 measurements and classified into 4 groups: increases in serum creatinine of <10%, 10% to 19%, 20% to 29%, and ≥30%. The primary study outcome was the composite of major macrovascular events, new or worsening nephropathy, and all-cause mortality. An acute increase in serum creatinine was associated with an elevated risk of the primary outcome (P for trend <0.001). The hazard ratios were 1.11 (95% CI, 0.97–1.28) for those with an increase of 10% to 19%, 1.34 (1.07–1.66) for 20% to 29%, and 1.44 (1.15–1.81) for ≥30%, compared with <10%. However, there was no evidence of heterogeneity in the benefit of randomized treatment effects on the outcome across subgroups defined by acute serum creatinine increase (P for heterogeneity=0.94). Acute increases in serum creatinine after starting perindopril-indapamide were associated with greater risks of subsequent major clinical outcomes. However, the continuation of angiotensin-converting enzyme inhibitor-based therapy reduced the long-term risk of major clinical outcomes, irrespective of acute increase in creatinine. |
| first_indexed | 2024-03-07T01:26:41Z |
| format | Journal article |
| id | oxford-uuid:92368217-252c-41eb-8433-fc85765ca4b3 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T01:26:41Z |
| publishDate | 2018 |
| publisher | American Heart Association |
| record_format | dspace |
| spelling | oxford-uuid:92368217-252c-41eb-8433-fc85765ca4b32022-03-26T23:23:56ZAcute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:92368217-252c-41eb-8433-fc85765ca4b3Symplectic Elements at OxfordAmerican Heart Association2018Ohkuma, TJun, MRodgers, ACooper, MGlasziou, PHamet, PHarrap, SMancia, GMarre, MNeal, BPerkovic, VPoulter, NWilliams, BZoungas, SChalmers, JWoodward, Mon behalf of the ADVANCE Collaborative GroupDiscontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creatinine are unclear. In the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), 11 140 diabetes mellitus patients were randomly assigned to perindopril-indapamide or placebo after a 6-week active run-in period. The current study included 11 066 participants with 2 serum creatinine measurements recorded before and during the active run-in period (3 weeks apart). Acute increase in creatinine was determined using these 2 measurements and classified into 4 groups: increases in serum creatinine of <10%, 10% to 19%, 20% to 29%, and ≥30%. The primary study outcome was the composite of major macrovascular events, new or worsening nephropathy, and all-cause mortality. An acute increase in serum creatinine was associated with an elevated risk of the primary outcome (P for trend <0.001). The hazard ratios were 1.11 (95% CI, 0.97–1.28) for those with an increase of 10% to 19%, 1.34 (1.07–1.66) for 20% to 29%, and 1.44 (1.15–1.81) for ≥30%, compared with <10%. However, there was no evidence of heterogeneity in the benefit of randomized treatment effects on the outcome across subgroups defined by acute serum creatinine increase (P for heterogeneity=0.94). Acute increases in serum creatinine after starting perindopril-indapamide were associated with greater risks of subsequent major clinical outcomes. However, the continuation of angiotensin-converting enzyme inhibitor-based therapy reduced the long-term risk of major clinical outcomes, irrespective of acute increase in creatinine. |
| spellingShingle | Ohkuma, T Jun, M Rodgers, A Cooper, M Glasziou, P Hamet, P Harrap, S Mancia, G Marre, M Neal, B Perkovic, V Poulter, N Williams, B Zoungas, S Chalmers, J Woodward, M on behalf of the ADVANCE Collaborative Group Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial |
| title | Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial |
| title_full | Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial |
| title_fullStr | Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial |
| title_full_unstemmed | Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial |
| title_short | Acute increases in serum creatinine after starting angiotensin-converting enzyme inhibitor-based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus: the ADVANCE trial |
| title_sort | acute increases in serum creatinine after starting angiotensin converting enzyme inhibitor based therapy and effects of its continuation on major clinical outcomes in type 2 diabetes mellitus the advance trial |
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