Denmark: A reduction in albuminuria during the 1st year in patients with type 2 diabetes is associated with lesser renal and cardiovascular outcomes, independent of treatment, finds a recent study in the journal Diabetes Care. Although not used to its full potential, monitoring of albuminuria remains an essential part of diabetes care.
Frederik Persson, Steno Diabetes Center Copenhagen, Gentofte, Denmark, and colleagues conducted a post hoc analysis of the LEADER trial to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events.
LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5–5 years in 9,340 participants with type 2 diabetes and high cardiovascular risk. The researchers calculated change in urinary albumin-to-creatinine ratio (UACR) from baseline to 1 year in participants with >30% reduction (n = 2,928), 30–0% reduction (n = 1,218), or any increase in UACR (n = 4,124), irrespective of treatment.
Risks of major adverse cardiovascular events (MACE) and a composite nephropathy outcome (from 1 year to end of trial in subgroups by baseline UACR [<30 mg/g, 30–300 mg/g, or ≥300 mg/g]) were assessed using Cox regression. The analysis was adjusted for treatment allocation alone as a fixed factor and for baseline variables associated with cardiovascular and renal outcomes.
Key findings of the study include:
For MACE, hazard ratios (HRs) for those with >30% and 30–0% UACR reduction were 0.82 and 0.99 respectively, compared with any increase in UACR (reference).
For the composite nephropathy outcome, respective HRs were 0.67 and 0.97.
Results were independent of baseline UACR and consistent in both treatment groups.
After adjustment, HRs were significant and consistent in >30% reduction subgroups with baseline micro- or macroalbuminuria.
"A reduction in albuminuria during the 1st year was associated with fewer cardiovascular and renal outcomes, independent of treatment," wrote the authors. "Albuminuria monitoring remains an important part of diabetes care, with great unused potential."
Reference:
The study titled, "Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial," is published in the journal Diabetes Care.
DOI: https://care.diabetesjournals.org/content/44/4/1020