Assuntos
Diabetes Insípido , Transplante de Rim , Doadores de Tecidos , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Diabetes Insípido/etiologia , Diabetes Insípido/epidemiologia , Adulto , Resultado do Tratamento , Transplantados , Estudos Retrospectivos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapiaRESUMO
BACKGROUND: Acute declines in estimated glomerular filtration rate (eGFR) occur commonly after starting angiotensin-converting enzyme inhibitors. Whether declines in eGFR that occur after simultaneously starting angiotensin-converting enzyme inhibitors with other antihypertensive agents modifies the benefits of these agents on cardiovascular outcomes is unclear. METHODS AND RESULTS: We identified predictors of acute declines in eGFR (>15% over 3 months) during randomization to benazepril plus amlodipine versus benazepril plus hydrochlorothiazide in the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) trial. We then determined the relation between declines in eGFR (treated as a binary variable, ≤15% versus >15% and separately, as a restricted spline variable) and the composite risk of fatal and nonfatal cardiovascular events using Cox proportional hazards models. We included 10 714 participants (median age 68 years [Q1 63, Q3 73]), of whom 1024 reached the trial end point over median follow-up of 2.8 years. Predictors of acute declines in eGFR>15% over 3 months included assignment to hydrochlorothiazide (versus amlodipine) and higher baseline albuminuria. Overall, declines in eGFR ≥15% (versus <15%) were associated with a 26% higher hazard of cardiovascular outcomes (95% CI, 1.07-1.48). In spline-based analysis, risk for cardiovascular outcomes was higher in the hydrochlorothiazide arm at every level of decline in eGFR compared with the same magnitude of eGFR decline in the amlodipine arm. CONCLUSION: Combined use of benazepril and amlodipine remains superior to benazepril and hydrochlorothiazide for cardiovascular outcomes, regardless of the magnitude of the decline in eGFR that occurred with initiation of therapy.
Assuntos
Anlodipino , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos , Benzazepinas , Quimioterapia Combinada , Taxa de Filtração Glomerular , Hidroclorotiazida , Hipertensão , Humanos , Anlodipino/uso terapêutico , Anlodipino/efeitos adversos , Hidroclorotiazida/uso terapêutico , Hidroclorotiazida/efeitos adversos , Masculino , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Idoso , Pessoa de Meia-Idade , Benzazepinas/uso terapêutico , Benzazepinas/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Resultado do Tratamento , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Rim/fisiopatologia , Rim/efeitos dos fármacos , Fatores de Tempo , Fatores de Risco , Medição de Risco , Bloqueadores dos Canais de Cálcio/uso terapêutico , Bloqueadores dos Canais de Cálcio/efeitos adversosRESUMO
In a cohort of 1817 children with type 1 diabetes (T1D), short-term hyperglycemia was associated with transient albuminuria (11 % during new-onset T1D without diabetic ketoacidosis (DKA), 12 % during/after DKA, 6 % during routine screening). Our findings have implications regarding future risk of diabetic kidney disease and further investigation is needed.