6533b85ffe1ef96bd12c1be8
RESEARCH PRODUCT
Liraglutide and Renal Outcomes in Type 2 Diabetes.
Mann JfeØRsted DdBrown-frandsen KMarso SpPoulter NrRasmussen STornøe KZinman BBuse JbLeader Steering Committee And Investigators. Bergenstal RDaniels GMoses AcNauck MNissen SPocock SSteinberg WStockner MKristensen PRavn LsZychma MFlyvbjerg AFord IKloos RtSchactman MjSleight PSwedberg KTenner SmAkalın SArechavaleta RBain SBabkowski McBenroubi MBerard LComlekci ACzupryniak LEliasson BEriksson MFonseca VFranek EGross JHafidh KHaluzik MHayes FHuang YyJacob SKaddaha GKhalil AKilhovd BLaakso MLeiter LLalic NJi LLuedemann JMannucci EMarre MMasmiquel LMota MOmar MO’shea DPan CPetrie JPieber TPratley RRaz IRea RRutten GSatman IShestakova MSimpson RSmith DTack CTarnow LThomas NVan Gaal LTravert FVidal JWarren MYoon KhTuttle RmSheerman SiHegedüs LBaerwald HBergenstal MCelik SDias CEder MFitzgibbons SIrvhage LKloluckova JKriulianski RMcduffie RMoen SPaster ASaalfeld RmSankar KShehaj ESwierzewska PTiktin MTovey SGibson CmChakrabarti AkDashe JfHinchey JLeary McPride YWiviott SAllen SMehr ApMutter WpParikh SRay SCheifetz ALeffler DSheth SAlexander EGaglia JlGoessling WMitzner LdRosenberg CSnow KjWagner APiazza GAbell SDavis 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MaleSettore MED/09 - Medicina InternaAcute Kidney Injury; Aged; Albuminuria; Creatinine; Diabetes Mellitus Type 2; Diabetic Nephropathies; Double-Blind Method; Female; Follow-Up Studies; Glomerular Filtration Rate; Glucagon-Like Peptide 1; Humans; Hypoglycemic Agents; Intention to Treat Analysis; Kidney Failure Chronic; Liraglutide; Male; Middle AgedType 2 diabetes030204 cardiovascular system & hematologyurologic and male genital diseasesGLOMERULAR-FILTRATION-RATEKIDNEY-FUNCTIONDISEASElaw.inventionKidney Failurechemistry.chemical_compound0302 clinical medicineRandomized controlled trialGlucagon-Like Peptide 1lawMedicineDiabetic NephropathiesHypoglycemic Agents.Settore MED/49 - Scienze Tecniche Dietetiche ApplicateChronicRISKKidneyAcute kidney injury11 Medical And Health SciencesGeneral MedicineAcute Kidney InjuryMiddle AgedIntention to Treat Analysismedicine.anatomical_structureCreatinineTRIALFemaleliraglutide randomized controlled trial type 2 diabetes renal outcomesLife Sciences & BiomedicineType 2Glomerular Filtration Ratemedicine.drugmedicine.medical_specialtyRenal function030209 endocrinology & metabolismCARDIOVASCULAR OUTCOMESFollow-Up Studie03 medical and health sciencesMedicine General & InternalDouble-Blind MethodGeneral & Internal MedicineDiabetes mellitusInternal medicineDiabetes MellitusAlbuminuriaHumansHypoglycemic AgentsIntensive care medicineAgedCreatinineScience & Technologybusiness.industryLiraglutideMORTALITYLiraglutidemedicine.diseaseINTENSIVE GLUCOSE CONTROLINDIVIDUALSDiabetes Mellitus Type 2chemistryDiabetic NephropathieKidney Failure ChronicLEADER Steering Committee and InvestigatorsbusinessFollow-Up Studiesdescription
BACKGROUND: In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown. METHODS: We report the prespecified secondary renal outcomes of that randomized, controlled trial in which patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use of time-to-event analyses with an intention-to-treat approach. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. RESULTS: A total of 9340 patients underwent randomization, and the median follow-up of the patients was 3.84 years. The renal outcome occurred in fewer participants in the liraglutide group than in the placebo group (268 of 4668 patients vs. 337 of 4672; hazard ratio, 0.78; 95% confidence interval [CI], 0.67 to 0.92; P=0.003). This result was driven primarily by the new onset of persistent macroalbuminuria, which occurred in fewer participants in the liraglutide group than in the placebo group (161 vs. 215 patients; hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P=0.004). The rates of renal adverse events were similar in the liraglutide group and the placebo group (15.1 events and 16.5 events per 1000 patient-years), including the rate of acute kidney injury (7.1 and 6.2 events per 1000 patient-years, respectively). CONCLUSIONS: This prespecified secondary analysis shows that, when added to usual care, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .).
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2017-08-31 |