ArticleClinical journal of the American Society of Nephrology : CJASN2026
A Hierarchical Composite Endpoint for Chronic Kidney Disease Progression in Patients with Focal Segmental Glomerulosclerosis.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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.
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.
Who cites it
1 citing paper in PubMed.
- Hierarchical Composite End Points: The Future of Randomized Trials of Kidney Disease?Clinical journal of the American Society of Nephrology : CJASN · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWe recently developed and validated a hierarchical composite endpoint (HCE) for chronic kidney disease (CKD) progression combining time-to-event kidney outcomes with the rate of estimated glomerular filtration rate (eGFR) decline (eGFR slope). The CKD progression HCE is an informative endpoint for clinical trials in rare kidney diseases, such as focal segmental glomerulosclerosis (FSGS), where event-driven trials are often infeasible.
methodsWe applied a HCE for CKD progression to the subset of patients with FSGS from the DAPA-CKD trial, a randomized double-blind, placebo-controlled clinical trial, to assess the effects of the sodium glucose co-transporter 2 inhibitor dapagliflozin on CKD progression in 4304 participants. We compared treatment effects for the primary composite endpoint (sustained 50% eGFR decline, kidney failure, or death due to kidney or cardiovascular causes), eGFR slope, and CKD progression HCE. We also compared statistical power for these outcomes using a bootstrap sampling procedure to evaluate the impact on trial efficiency.
resultsOverall, 115 participants were included (mean age, 54 years; 68% male; median urinary albumin-to-creatinine ratio, 1283 mg/g; mean eGFR, 42 mL/min/1.73m2). The effect of dapagliflozin on the primary composite endpoint (hazard ratio 0.45 [95% confidence interval [CI]: 0.13, 1.49]) and total eGFR slope (0.9 mL/min/1.73m2 (95%CI: -0.6, 2.3) were consistent with the overall trial results but the 95% CI crossed unity. The win-odds for the CKD progression HCE suggested benefits for dapagliflozin and the 95%CI did not cross unity (win-odds: 1.52 [95%CI: 1.01, 2.28]). Power calculations suggested that for a given sample size, statistical power was higher for the CKD progression HCE compared with the primary composite endpoint or eGFR slope.
conclusionOur findings suggest that a CKD progression HCE, which integrates established CKD endpoints and eGFR slope, provides a sensitive and efficient measure to assess treatment effects in patients with FSGS. Validation of the HCE in prospective clinical trials will support its implementation.
Identifiers
What OpenQuestion holds
Registered trials
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.