Evidence map›Paper›PMID 31160317›Full record

Observational studyClinical journal of the American Society of Nephrology : CJASN2019

Combination of Changes in Estimated GFR and Albuminuria and the Risk of Major Clinical Outcomes.

Toshiaki Ohkuma, Min Jun, John Chalmers, Mark E Cooper, Pavel Hamet, Stephen Harrap, Sophia Zoungas, Vlado Perkovic, Mark Woodward, ADVANCE Collaborative Group

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Clinical journal of the American Society of Nephrology : CJASN, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 7% 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

29 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 5 countries.

Toshiaki OhkumaThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Min JunThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
John ChalmersThe George Institute for Global Health, University of New South Wales, Sydney, Australia.ORCID 0000-0002-9931-0580
Mark E CooperCentral Clinical School and.
Pavel HametCenter de Rechercher, Center Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Stephen HarrapDepartment of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.
Sophia ZoungasThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Vlado PerkovicThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Mark WoodwardThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
ADVANCE Collaborative Group
UNSW Sydney · AUCentral Clinical Hospital · PLCentre Hospitalier de l’Université de Montréal · CAJohns Hopkins University · USThe Royal Melbourne Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesWhether combining changes in eGFR and urine albumin-to-creatinine ratio (UACR) is more strongly associated with outcomes compared with either change alone is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We analyzed 8766 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (ADVANCE-ON) study. Changes in eGFR and UACR (baseline to 2 years) were defined as ≥40% decrease, minor change, and ≥40% increase. The primary outcome was the composite of major macrovascular (nonfatal or fatal myocardial infarction, nonfatal or fatal stroke, or cardiovascular death), major kidney events (requirement for kidney replacement therapy or kidney death), and all-cause mortality.

resultsOver a median of 7.7 years of follow-up, 2191 primary outcomes were recorded. Strong linear associations between eGFR and UACR changes and subsequent risk of the outcome were observed. For eGFR, the hazard ratios were 1.58 (95% confidence interval [95% CI], 1.27 to 1.95) for a decrease ≥40% and 0.82 for an increase ≥40% (95% CI, 0.64 to 1.04) compared with minor change. For UACR, the hazard ratios were 0.96 (95% CI, 0.85 to 1.07) for a decrease ≥40% and 1.32 (95% CI, 1.19 to 1.46) for ≥40% increase compared with minor change. Compared with dual minor changes, both an eGFR decrease ≥40% and a UACR increase ≥40% had 2.31 (95% CI, 1.67 to 3.18) times the risk of the outcome, with evidence of interaction between the two markers.

conclusionsClinically meaningful decreases in eGFR and increases in UACR over 2 years, independently and in combination, were significantly associated with higher risk of major clinical outcomes.

Indexed as

Glomerular Filtration RateAgedAlbuminuriaCardiovascular DiseasesCreatinineDiabetes Mellitus, Type 2Diabetic NephropathiesFemaleFollow-Up StudiesHumansMaleMiddle AgedMortalityMyocardial InfarctionRandomized Controlled Trials as TopicRenal Replacement TherapyCreatinineAlbuminsalbuminuriacardiovascular diseasecreatininediabetes mellitusDiabetes Mellitus, Type 2ESKDESRDglomerular filtration ratekidneyMyocardial InfarctionRenal Replacement TherapyRiskStroke

Identifiers

PMID31160317
PMCPMC6556720
OpenAlexW2948767173

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.