دورية أكاديمية
Acute Treatment Effects on GFR in Randomized Clinical Trials of Kidney Disease Progression
| العنوان: | Acute Treatment Effects on GFR in Randomized Clinical Trials of Kidney Disease Progression |
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| المؤلفون: | Neuen, BL, Tighiouart, H, Heerspink, HJL, Vonesh, EF, Chaudhari, J, Miao, S, Chan, TM, Fervenza, FC, Floege, J, Goicoechea, M, Herrington, WG, Imai, E, Jafar, TH, Lewis, JB, Li, PKT, Locatelli, F, Maes, BD, Perrone, RD, Praga, M, Perna, A, Schena, FP, Wanner, C, Wetzels, JFM, Woodward, M, Xie, D, Greene, T, Inker, LA |
| المصدر: | urn:ISSN:1046-6673 ; urn:ISSN:1533-3450 ; Journal of the American Society of Nephrology, 33, 2, 291-303 |
| بيانات النشر: | Wolters Kluwer |
| سنة النشر: | 2022 |
| المجموعة: | UNSW Sydney (The University of New South Wales): UNSWorks |
| مصطلحات موضوعية: | Clinical Research, Clinical Trials and Supportive Activities, Kidney Disease, Renal and urogenital, Albuminuria, Antihypertensive Agents, Creatinine, Disease Progression, Female, Glomerular Filtration Rate, Humans, Immunosuppressive Agents, Male, Randomized Controlled Trials as Topic, Renal Insufficiency, Chronic, Renin-Angiotensin System, Sodium-Glucose Transporter 2 Inhibitors, acute decline in GFR, chronic kidney disease, randomized controlled trials, CKD-EPI Clinical Trials, anzsrc-for: 1103 Clinical Sciences |
| الوصف: | Background Acute changes in GFR can occur after initiation of interventions targeting progression of CKD. These acute changes complicate the interpretation of long-term treatment effects. Methods To assess the magnitude and consistency of acute effects in randomized clinical trials and explore factors that might affect them, we performed a meta-analysis of 53 randomized clinical trials for CKD progression, enrolling 56,413 participants with at least one estimated GFR measurement by 6 months after randomization. We defined acute treatment effects as the mean difference in GFR slope from baseline to 3 months between randomized groups. We performed univariable and multivariable metaregression to assess the effect of intervention type, disease state, baseline GFR, and albuminuria on the magnitude of acute effects. Results The mean acute effect across all studies was 20.21 ml/min per 1.73 m2 (95% confidence interval, 20.63 to 0.22) over 3 months, with substantial heterogeneity across interventions (95% coverage interval across studies, 22.50 to 12.08 ml/min per 1.73 m2). We observed negative average acute effects in renin angiotensin system blockade, BP lowering, and sodium-glucose cotransporter 2 inhibitor trials, and positive acute effects in trials of immunosuppressive agents. Larger negative acute effects were observed in trials with a higher mean baseline GFR. Conclusion The magnitude and consistency of acute GFR effects vary across different interventions, and are larger at higher baseline GFR. Understanding the nature and magnitude of acute effects can help inform the optimal design of randomized clinical trials evaluating disease progression in CKD. |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | unknown |
| العلاقة: | http://hdl.handle.net/1959.4/unsworks_82833Test; https://unsworks.unsw.edu.au/bitstreams/778d9419-2f3c-48d5-9f85-9c204a4bd82a/downloadTest; https://doi.org/10.1681/ASN.2021070948Test |
| DOI: | 10.1681/ASN.2021070948 |
| الإتاحة: | https://doi.org/10.1681/ASN.2021070948Test http://hdl.handle.net/1959.4/unsworks_82833Test https://unsworks.unsw.edu.au/bitstreams/778d9419-2f3c-48d5-9f85-9c204a4bd82a/downloadTest |
| حقوق: | open access ; https://purl.org/coar/access_right/c_abf2Test ; CC-BY ; https://creativecommons.org/licenses/by/4.0Test/ ; free_to_read |
| رقم الانضمام: | edsbas.E0C6BF97 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1681/ASN.2021070948 |
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