Evidence map›Paper›PMID 23929924›Full record

Trial reportClinical journal of the American Society of Nephrology : CJASN2013

Determinants and changes associated with aldosterone breakthrough after angiotensin II receptor blockade in patients with type 2 diabetes with overt nephropathy.

Olivier Moranne, George Bakris, Coraline Fafin, Guillaume Favre, Christian Pradier, Vincent L M Esnault

Open access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical journal of the American Society of Nephrology : CJASN, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 1 pooled it
2.5field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Review
  7. Review
  8. Review
  9. Review
  10. Review
  11. Mitigating risk of aldosterone in diabetic kidney disease.Current opinion in nephrology and hypertension · 2020
    Review
  12. Article
  13. Review
  14. Review
  15. New molecular insights in diabetic nephropathy.International urology and nephrology · 2016
    Review
  16. Review
  17. Review
  18. Aldosterone breakthrough during angiotensin receptor blocker use: more questions than answers?Clinical journal of the American Society of Nephrology : CJASN · 2013
    Article
  19. Article
  20. Aldosterone breakthrough does not alter central hemodynamics.Journal of the renin-angiotensin-aldosterone system : JRAAS
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

Olivier MoranneNephrology and, †Epidemiology Departments, Nice University Hospital, Nice, France;, ‡ASH Comprehensive Hypertension Center, University of Chicago, Chicago, Illinois, §Institut National de la Santé et de la Recherche Médicale U1081, Nice Sophia-Antipolis University, Nice, France.
George Bakris
Coraline Fafin
Guillaume Favre
Christian Pradier
Vincent L M Esnault
Centre Hospitalier Universitaire de Nice · FRPediatric Nephrology of Alabama · USHypertension Institute · USUniversité Côte d'Azur · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesInhibition of the renin-angiotensin-aldosterone system decreases proteinuria and slows estimated GFR decline in patients with type 2 diabetes mellitus with overt nephropathy. Serum aldosterone levels may increase during renin-angiotensin-aldosterone system blockade. The determinants and consequences of this aldosterone breakthrough remain unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study examined the incidence, determinants, and changes associated with aldosterone breakthrough in a posthoc analysis of a randomized study that compared the effect of two angiotensin II receptor blockers in patients with type 2 diabetes mellitus with overt nephropathy.

resultsOf 567 of 860 participants included in this posthoc analysis, 28% of participants developed aldosterone breakthrough, which was defined by an increase greater than 10% over baseline values of serum aldosterone levels after 1 year of angiotensin II receptor blocker treatment. Factors independently associated with aldosterone breakthrough at 1 year were lower serum aldosterone and potassium levels at baseline, higher decreases in sodium intake, systolic BP, and estimated GFR from baseline to 1 year, and use of losartan versus telmisartan. Aldosterone breakthrough at 6 months was not sustained at 1 year in 69% of cases, and it did not predict estimated GFR decrease and proteinuria increase between 6 months and 1 year.

conclusionsAldosterone breakthrough is a frequent event 1 year after initiating renin-angiotensin-aldosterone system blockade, particularly in participants exposed to intensive lowering of BP with sodium depletion and short-acting angiotensin II receptor blockers. Short-term serum aldosterone level increases at 6 months are not associated with negative kidney outcomes between 6 months and 1 year.

Indexed as

AgedAldosteroneAngiotensin Receptor AntagonistsDiabetes Mellitus, Type 2Diabetic NephropathiesDouble-Blind MethodFemaleGlomerular Filtration RateHumansMaleMiddle AgedProspective StudiesSodium, DietaryAldosteroneAngiotensin Receptor AntagonistsSodium, Dietary

Identifiers

PMID23929924
PMCPMC3789346
OpenAlexW2104804571

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.