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Assessing the Validity of Surrogate Outcomes for ESRD: A Meta-Analysis.
Jun, Min; Turin, Tanvir Chowdhury; Woodward, Mark; Perkovic, Vlado; Lambers Heerspink, Hiddo J; Manns, Braden J; Tonelli, Marcello; Hemmelgarn, Brenda R.
Afiliação
  • Jun M; Department of Medicine, Division of Nephrology, The George Institute for Global Health, The University of Sydney, Sydney, Australia;
  • Turin TC; Department of Community Health Sciences, and Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada;
  • Woodward M; Department of Community Health Sciences, and The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and.
  • Perkovic V; The George Institute for Global Health, The University of Sydney, Sydney, Australia;
  • Lambers Heerspink HJ; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
  • Manns BJ; Department of Medicine, Division of Nephrology, Department of Community Health Sciences, and.
  • Tonelli M; Department of Community Health Sciences, and.
  • Hemmelgarn BR; Department of Medicine, Division of Nephrology, Department of Community Health Sciences, and Brenda.Hemmelgarn@albertahealthservices.ca.
J Am Soc Nephrol ; 26(9): 2289-302, 2015 Sep.
Article em En | MEDLINE | ID: mdl-25556165
Validation of current and promising surrogate outcomes for ESRD in randomized controlled trials (RCTs) has been limited. We conducted a systematic review and meta-analysis of RCTs to further inform the ability of surrogate outcomes for ESRD to predict the efficacy of various interventions on ESRD. MEDLINE, EMBASE, and CENTRAL (from inception through September 2013) were searched. All RCTs in adults with proteinuria, diabetes, or CKD stages 1-4 or renal transplant recipients reporting ≥10 ESRD events and a surrogate outcome (change in proteinuria or doubling of serum creatinine [DSCR]) for ESRD during a ≥1-year follow-up were included. Two reviewers abstracted trial characteristics and outcome data independently. To assess the correlation between the surrogate outcomes and ESRD, we determined the treatment effect ratio (TER), defined as the ratio of the treatment effects on ESRD and the effects on the change in surrogate outcomes. TERs close to 1 indicate greater agreement between ESRD and the surrogate, and these ratios were pooled across interventions. We identified 27 trials (97,458 participants; 4187 participants with ESRD). Seven trials reported the effects on change in proteinuria and showed consistent effects for proteinuria and ESRD (TER, 0.82; 95% confidence interval, 0.59 to 1.16), with minimal heterogeneity. Twenty trials reported on DSCR. Treatment effects on DSCR were consistent with the effects on ESRD (TER, 0.98; 95% confidence interval, 0.85 to 1.14), with moderate heterogeneity. In conclusion, DSCR is generally a good surrogate for ESRD, whereas data on proteinuria were limited. Further assessment of the surrogacy of proteinuria using prospective RCTs is warranted.
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Texto completo: 1 Eixos temáticos: Pesquisa_clinica Base de dados: MEDLINE Assunto principal: Proteinúria / Creatinina / Falência Renal Crônica Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2015 Tipo de documento: Article

Texto completo: 1 Eixos temáticos: Pesquisa_clinica Base de dados: MEDLINE Assunto principal: Proteinúria / Creatinina / Falência Renal Crônica Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2015 Tipo de documento: Article