Kidney Week

Abstract: FR-PO462

Increasing Baseline Albuminuria Is Associated with a Continuously Increased Risk of Cardiovascular (CV) and Renal Outcomes in the LEADER Trial

Session Information

• Diabetic Kidney Disease: Clinical - I
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Mosenzon, Ofri, Hadassah Hebrew University Hospital, Jerusalem, Israel

Ofri Mosenzon,

• Bain, Stephen, Institute of Life Science, Swansea University, Swansea, United Kingdom

Stephen Bain,

• Persson, Frederik, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Frederik Persson,

• Lambers Heerspink, Hiddo Jan, University Medical Center Groningen, Groningen, Netherlands

Hiddo Jan Lambers Heerspink,

• Mann, Johannes F., KfH Kidney Center, and Friedrich Alexander University of Erlangen, Munich, Germany

Johannes F. Mann,

• Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark

Peter Rossing,

• Idorn, Thomas, Novo Nordisk A/S, Soborg, Denmark

Thomas Idorn,

• Rasmussen, Soren, Novo Nordisk A/S, Soborg, Denmark

Soren Rasmussen,

• Von Scholten, Bernt Johan, Novo Nordisk A/S, Soborg, Denmark

Bernt Johan Von Scholten,

• Raz, Itamar, Hadassah Hebrew University Hospital, Jerusalem, Israel

Itamar Raz,

Group or Team Name

• The LEADER Publication Committee on behalf of the LEADER Trial Investigators

Background

Albuminuria is a known risk factor for CV disease, but the lower limit from which it is a risk factor is not well defined.

Methods

We assessed CV and renal outcomes by increasing levels of baseline urinary albumin-to-creatinine ratio (UACR) in the LEADER trial. LEADER was a randomized, double-blind, placebo-controlled CV outcomes trial of liraglutide up to 1.8 mg/day vs placebo added to standard care for 3.5–5 years in 9340 patients with type 2 diabetes and high risk for CV disease. We analyzed the risk of major adverse CV events (MACE), expanded MACE, all-cause death, and adjudicated renal events (doubling of serum creatinine and estimated glomerular filtration rate ≤45 ml/min/1.73 m²; the need for continuous renal-replacement therapy; or death from renal disease) by baseline UACR irrespective of treatment group; UACR < lower limit of quantification (LLoQ) (G0; n=1598), 0 to <15 mg/g (G1; n=2905), 15 to <30 mg/g (G2; n=1196), 30 to <100 mg/g (G3; n=1609), 100 to <300 mg/g (G4; n=845), and ≥300 mg/g (G5; n=960).

Results

The risk of MACE, expanded MACE, all-cause death and renal events increased with increasing baseline UACR (Figure), statistically significant for all subgroups with UACR ≥30 mg/g compared to G0. Interestingly, in patients at the higher part of the normoalbuminuric range (G2), a trend towards increased risk for CV events and all-cause death was observed.

Conclusion

In LEADER, baseline UACR≥30 mg/g was associated with increased risk of death, and CV and renal events, emphasizing the importance of albuminuria as a modifiable risk factor.

Funding

• Commercial Support – Novo Nordisk