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Cardiovascular and renal outcomes by baseline albuminuria status and renal function: Results from the LEADER randomized trial
Author(s) -
Mosenzon Ofri,
Bain Stephen C.,
Heerspink Hiddo J. L.,
Idorn Thomas,
Mann Johannes F. E.,
Persson Frederik,
Pratley Richard E.,
Rasmussen Søren,
Rossing Peter,
von Scholten Bernt Johan,
Raz Itamar
Publication year - 2020
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14126
Subject(s) - medicine , renal function , albuminuria , myocardial infarction , population , creatinine , hazard ratio , type 2 diabetes , stroke (engine) , heart failure , post hoc analysis , urology , diabetes mellitus , cardiology , endocrinology , confidence interval , mechanical engineering , environmental health , engineering
Aim To assess cardiorenal outcomes by baseline urinary albumin‐to‐creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) in the contemporary LEADER cohort. Materials and methods LEADER was a multinational, double‐blind trial. Patients with type 2 diabetes and high cardiovascular (CV) risk were randomized 1:1 to the glucagon‐like peptide‐1 analogue liraglutide (≤1.8 mg daily; n = 4668) or placebo (n = 4672) plus standard care and followed for 3.5 to 5 years. Primary composite outcomes were time to first non‐fatal myocardial infarction, non‐fatal stroke or CV death. Post hoc Cox regression analyses of outcomes by baseline UACR and eGFR subgroups were conducted with adjustment for baseline variables. Results In the LEADER population, 1598 (17.5%), 2917 (31.9%), 1200 (13.1%), 1611 (17.6%), 845 (9.2%) and 966 (10.6%) had UACR = 0, >0 to <15, 15 to <30, 30 to <100, 100 to <300 and ≥300 mg/g, respectively. Increasing UACR and decreasing eGFR were linked with higher risks of the primary outcome, heart failure hospitalization, a composite renal outcome and death ( P ‐values for the Cochran‐Armitage test for trends were all <.0001). Across UACR and eGFR subgroups, risks of cardiorenal events and death were generally lower or similar with liraglutide versus placebo. Conclusions In a contemporary type 2 diabetes population, increasing baseline UACR and declining eGFR were linked with higher risks of cardiorenal events and death.