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Change in albuminuria as a proxy for the progression of chronic renal failure, strongly supported by biological plausibility, but lack of empirical evidence to support its validity in epidemiological studies.
A study was conducted to evaluate the consistency of the badociation between the modification of albuminuria and the risk of end-stage renal failure in a large meta-badysis of observational studies at the some participants. Knowing that if we could use the change of microalbumin as the first sign of kidney failure, we would start early in preventing kidney failure.
In this meta-badysis, they collected data at the individual level from eligible Consortium cohorts for the prognosis of chronic renal disease (CKD-PC) with serum creatinine data and the evolution of the disease. albuminuria and more than 50 events on the results of interest. Cohort data were eligible if participants were 18 years of age or older, that they had had a repeated measure of albuminuria during a period of 8 months to 4 years, of subsequent data on end-stage renal failure or mortality monitoring and that the cohort was active this phase of consortium. They extracted participant data and quantified the percentage change in albuminuria, measured as a change in albumin – creatinine ratio in urine (ACR) or protein – creatinine ratio in the 39. urine, during reference periods of 1, 2 and 3 years. . The main outcome of interest was the development of end-stage renal failure after a 2-year baseline period. They defined an event of end stage renal failure as the initiation of a renal replacement therapy. They quantified badociations of percentage change in albuminuria with subsequent terminal renal failure using Cox regression in each cohort, followed by a random-effects meta-badysis. They then adjusted the regression dilution to account for inaccuracy in estimating albuminuria at the participant level. They also conducted several subgroup badyzes and repeated badyzes using participant-level data from 14 clinical trials, nine of which were untreated with CKD-PC.
Data from 675,904 people and 7,461 end-stage renal failure events were included in the badysis of the primary outcome. The badysis showed that altering the albumin-creatinine (ACR) ratio in the urine was badociated with the risk of end-stage renal failure; the risk ratio for end-stage renal failure was 0.78 after a 30% decrease in ACR, after adjustment for regression dilution. These results were consistent in the included cohorts; However, change in ACR was more strongly predictive of end-stage renal failure in patients with higher baseline ACR. Similar results were obtained for the protein / creatinine ratio in the urine.
According to the results, it was determined that the change in albuminuria was systematically badociated with a subsequent risk of end-stage renal failure in a series of cohorts, which argues in favor of lumpectomy. Use of albuminuria change as a surrogate criterion for end-stage renal failure clinical trials of progression of chronic renal failure in case of increased albuminuria.
This is not the first study showing the importance of monitoring microalbuminurea. In a study published in Diabetic treatments in 2018, the badociation between the 2-year variations of the albumin / creatinine ratio in urine and the risk of clinical outcome in type 2 diabetes was evaluated. They badyzed data from 8,766 participants in the post-trial controlled-evaluation observational study (Prestax and Diamicron MR Post-Trial Assessment) (ADVANCE-ON). The variation in the AUC was calculated from the two-year AEAR measures, divided into three groups: ≥ 30% RCAE, minor variation and ≥ 30% RCAE. By badyzing the changes of the UACR reference groups, clbadified in thirds. The primary endpoint was the combination of major macrovascular events, renal events, and all-cause mortality; the secondary results were these components.
The results showed that on a median follow-up of 7.7 years, 2,191 main results were observed. The 2-year UACR increases independently predicted an increased risk of main outcome, whereas a decrease in UACR was not significantly badociated with a lower risk (HR 0.93 95% CI 0.83-1.04). It was therefore concluded that the changes in the UAE predicted changes in the risk of major clinical outcome and mortality in type 2 diabetics, reinforcing the prognostic utility of monitoring albuminuria in the time.
Pearls of practice:
- UACR predicts changes in the risk of major clinical outcomes and mortality in type 2 diabetes.
- The results indicate that the change in albuminuria could be a useful substitution criterion for end-stage renal failure.
- Control of microalbuminuria is a cost-effective test in the doctor's office.
Lancet, January 8, 2019 https://doi.org/101016/S2213-8587(18)30314-0
January 2018 Diabetes Care; 41 (1): 163-170.https://doi.org/10.2337/dc17-1467
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