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Intensive glycemic control reduces risk for adverse kidney outcomes in ACCORDION
NEW ORLEANS — Long-term risk for macroalbuminuria, creatinine doubling, end-stage renal disease and all-cause mortality was increased with intensive blood pressure control and fenofibrate therapy, whereas intensive glycemic control reduced risk for these outcomes in people with type 2 diabetes, according to results of the ACCORDION study.
ACCORDION is an extension phase of the ACCORD trial, designed to evaluate the effects of intensive glycemic control (HbA1c < 6%), BP control (systolic BP < 120 mm Hg) and fenofibrate use on cardiovascular events and death. Participants were followed an additional 6.5 years after the 3.5-year trial.
“Targeting [systolic BP less than] 120 mm Hg or add-on fenofibrate to statin therapy may be harmful to long-term risk of chronic kidney disease,” Amy K. Mottl, MD, PhD, of the Diabetes Center for Research at the University of North Carolina at Chapel Hill School of Medicine, told Endocrine Today. “The utility of targeting HbA1c to less than 6% may be useful in decreasing the long-term risk of [chronic kidney disease], but this effect must be balanced with the risk for cardiovascular events — as seen in the primary trial.”
Amy K. Mottl
Mottl and colleagues evaluated patients with type 2 diabetes (mean age, 62 years; 38% women) to examine the composite kidney outcome of macroalbuminuria, creatinine doubling, end-stage renal disease or death by any cause with intensive glycemic control (n = 10,139), BP control (n = 4,682) or fenofibrate use (n = 5,457).
Thirty-five percent of all participants had no chronic kidney disease (CKD), 8% had at least stage 3 CKD, 25% had microalbuminuria and 5% had macroalbuminuria.
In the intensive glycemic control group, univariate analysis yielded an HR of 0.92 (95% CI, 0.86-0.99) for the composite outcome; 0.72 (95% CI, 0.64-0.82) for macroalbuminuria; 1.05 (95% CI, 0.93-1.2) for creatinine doubling; 0.84 (0.68-1.04) for end-stage renal disease and 1 (95% CI, 0.91-1.09) for all-cause mortality. Multivariate analysis yielded a similar reduction in the composite outcome (HR = 0.92; 95% CI, 0.86-0.98).
In the intensive BP control group, the HRs were 1.15 (95% CI, 1.04-1.27) for the composite outcome; 1 (95% CI, 0.83-1.21) for macroalbuminuria; 1.52 (95% CI, 1.25-1.85) for creatinine doubling; 0.91 (95% CI, 0.61-1.25) for end-stage renal disease; and 1.03 (95% CI, 0.9-1.18) for all-cause mortality. Increased risk for the composite outcome (HR = 1.16; 95% CI, 1.05-1.28) and creatinine doubling (HR = 1.64; 95% CI, 1.3-2.06) persisted in multivariate analyses.
In the fenofibrate therapy group, the HRs were 1.15 (1.05-1.26) for the composite outcome; 1.19 (95% CI, 1-1.4) for macroalbuminuria; 1.83 (95% CI, 1.54-2.18) for creatinine doubling; 0.97 (95% CI, 0.74-1.29) for end-stage renal disease; and 0.95 (95% CI, 0.84-1.06) for all-cause mortality. Again, increased risk for the composite outcome (HR = 1.16; 95% CI, 1.06-1.27) and creatinine doubling (HR = 2; 95% CI, 1.61-2.49) persisted in multivariate analyses.
“In the secondary analyses of a large type 2 diabetes cohort at high risk for CV complications, targeting an HbA1c [less than] 6% decreased the risk, whereas targeting systolic BP [less than] 120 mm Hg and fenofibrate add-on to statin therapy increased the risk of subsequent composite renal outcomes — incident macroalbuminaria, doubling of creatinine, [end-stage renal disease] or death,” Mottl told Endocrine Today. – by Amber Cox
Reference:
Mottl AK, et al. Poster 535-P. Presented at: American Diabetes Association Scientific Sessions; June 10-14, 2016; New Orleans.
Disclosure: Mottl reports no relevant financial disclosures.