Observational studyBMC nephrology2016

The importance of proteinuria and prior cardiovascular disease in all major clinical outcomes of atherosclerotic renovascular disease - a single-center observational study.

Diana Vassallo, James Ritchie, Darren Green, Constantina Chrysochou, Joseph Blunt, Philip A Kalra

Open access · goldFull text readObservational Study
In one paragraph

Observational study in BMC nephrology, 2016. The graph read 7 numbers from its abstract, feeding 6 cells of the map, but none could be read as for or against, so it casts no vote. It also reports 6 associations that do not count as treatment evidence, such as HR 0.79 (0.66 to 0.94) for Death. Not yet cited in PubMed.

7numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.5field-weighted citation impact, top 26% 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.

Read, but not usablea number the graph found but could not read as for or against

DeathStatins at baseline vs No statins at baselinean association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.790.66 to 0.94
Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]).
ESKDRenin angiotensin blockade (RAB) at baseline vs No renin angiotensin blockade at baselinean association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.840.71 to 1.00
Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]).
DeathHigher estimated glomerular filtration rate at time of diagnosis vs Lower estimated glomerular filtration rate at time of diagnosisan association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.920.89 to 0.94
Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]).
DeathRenin angiotensin blockade (RAB) at baseline vs No renin angiotensin blockade at baselinean association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.830.70 to 0.98
Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]).
DeathRevascularization vs No revascularizationan association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.650.51 to 0.83
Revascularization was associated with reduced risk of death (HR 0.65 [95% CI 0.51-0.83]) and ESKD (HR 0.59 [95% CI 0.46-0.76]).
ESKDStatins at baseline vs No statins at baselinean association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.790.66 to 0.93
Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]).
ESKDRevascularization vs No revascularizationan association or prognostic statement, not a treatment comparison · ascvd, heart_failurefeeds one cell of the map
HR 0.590.46 to 0.76
Revascularization was associated with reduced risk of death (HR 0.65 [95% CI 0.51-0.83]) and ESKD (HR 0.59 [95% CI 0.46-0.76]).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Antihypertensives×kidney outcomes

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 1 favour the treatment, 0 find no difference, 0 favour the comparator.

Belief with this paper
0.50one trial · 1 family supports, 0 contradict · head-to-head
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
0 · no effect
NCT00976495154 enrolled · 2009
Δ -7.62-12.9 to -2.06

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Antihypertensives×all-cause mortality

No readable resultOpen on the map →What to test next →

No other readable study in this cell yet. This paper is the evidence.

Belief with this paperNo claim has been compiled for this cell yet.

Cardiac procedures & devices×all-cause mortality

No readable resultOpen on the map →What to test next →

No other readable study in this cell yet. This paper is the evidence.

Belief with this paperNo claim has been compiled for this cell yet.

Cardiac procedures & devices×kidney outcomes

No readable resultOpen on the map →What to test next →

No other readable study in this cell yet. This paper is the evidence.

Belief with this paperNo claim has been compiled for this cell yet.

Statins×all-cause mortality

No readable resultOpen on the map →What to test next →

13 readable studies in this cell: 4 favour the treatment, 8 find no difference, 1 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×kidney outcomes

No readable resultOpen on the map →What to test next →

4 readable studies in this cell: 0 favour the treatment, 3 find no difference, 1 favour the comparator.

Belief with this paper
0.00contested · 0 families support, 1 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.600.14 to 2.51

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · 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.

5 · Its place in the literature

Who cites it

0 citing papers in PubMed, 4 citations in OpenAlex.

No citing paper in PubMed yet.

6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Diana VassalloDepartment of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom. vassallodi@gmail.com.ORCID 0000-0003-3265-6744
James RitchieDepartment of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.
Darren GreenDepartment of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.
Constantina ChrysochouDepartment of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.
Joseph BluntDepartment of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.
Philip A KalraDepartment of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.
Salford Royal NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundIdentification of patients at risk of developing adverse events would enable aggressive medical therapy and possibly targeted revascularization. The aim of this study is to characterize the determinants of long-term outcomes in atherosclerotic renovascular disease (ARVD).

methodsPatients with a radiological diagnosis of ARVD were recruited into this single-center prospective cohort study between 1986 and 2014. Data collected included baseline co-morbid conditions, annualized prescribed medications and laboratory data (serum creatinine [υmol/L], proteinuria [g/24 h]). Multivariable Cox regression analysis was used to explore association with these end-points: death, end-stage kidney disease (ESKD), cardiovascular event (CVE) and the first of any of these events.

resultsA total of 872 patients were recruited into this study. However, 42 patients were excluded due to missing baseline data and hence case records for 830 patients were reviewed. Over median follow-up of 57.1 months (interquartile range: 21.7-96.9), incidence per 100 patient years of death, ESKD, CVE and any event was 13.5, 4.2, 8.9 and 21.0 respectively. Macrovascular disease (MVD), congestive heart failure (CHF), flash pulmonary oedema (FPE) and greater proteinuria at baseline were individually associated with increased risk for all end-points in multivariable analysis (Death: MVD -HR 1.24 [95% CI 1.02-1.50]; CHF -HR 1.33 [95% CI 1.08-1.64]; FPE - HR 2.10 [95% CI 1.50-2.92]; proteinuria - HR 1.14 [95% CI 1.08-1.20]). Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]). Revascularization was associated with reduced risk of death (HR 0.65 [95% CI 0.51-0.83]) and ESKD (HR 0.59 [95% CI 0.46-0.76]).

conclusionAll patients with ARVD require intensive vascular protection therapy to help mitigate systemic atherosclerosis, optimize cardiovascular risk and improve clinical outcomes. More effort is required to identify the minority of patients who may benefit from revascularization.

Indexed as

Adrenergic beta-AntagonistsAgedAge FactorsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAtherosclerosisCardiovascular DiseasesComorbidityCoronary Artery DiseaseFemaleGlomerular Filtration RateHeart FailureHumansHydroxymethylglutaryl-CoA Reductase InhibitorsKidney Failure, ChronicMaleAdrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHydroxymethylglutaryl-CoA Reductase InhibitorsAtherosclerotic renovascular diseaseCardiovascular eventsEnd-stage kidney diseaseMortalityProteinuriaRevascularization

Identifiers

PMID27927187
PMCPMC5142339
OpenAlexW2560017124

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Textfull text, public
LicenceCC BY
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.