EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETES OFFICIAL HIGHLIGHTS

EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETES

Conference summaries


DIABETES & CKD

Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria: (PRIORITY) study

Presented by: Gemma Currie, MBChB, MRCP
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Morten Lindhardt, MD, PhD
McMaster University & Hamilton Health Sciences, Hamilton, Canada
  • The urinary proteomic classifier CKD273 can aid in predicting progression to microalbuminuria in patients with type 2 diabetes and normoalbuminuria.
  • Spironolactone does not reduce progression to microalbuminuria in patients who are classified to be at high-risk.
  • CKD273 may be useful to predict a decline in renal function, and may be of benefit in routine management.

A specific risk classifier based on urinary proteomics (chronic kidney disease (CKD)273) has been shown to identify normoalbuminuric patients with diabetes who later progressed to overt kidney disease, and may hold the potential for selection of high-risk patients for early intervention. Combining the ability of CKD273 to identify patients at highest risk of progression with prescription of preventive aldosterone blockade only in this high-risk population may increase this power.

  • The PRIORITY study investigated the ability of CKD273 to predict the development of microalbuminuria in patients with type 2 diabetes and determined whether early intervention with spironolactone can reduce the risk of developing microalbuminuria.

Type of study, patients, and inclusion criteria

  • Investigator-initiated, prospective multicentre clinical trial, with randomised double-masked placebo-controlled intervention in high-risk patients and a prospective observational phase in low-risk patients.
  • Risk was determined by classification with CKD273.
  • High-risk patients were randomised to placebo or spironolactone.
  • Type 2 diabetes with preserved renal function (estimated glomerular filtration rate (eGFR) >45 mL/min/1.73 m2) and normoalbuminuria (urine albumin to creatinine ratio (UACR) <30 mg/g in two of three consecutive morning urine samples).
  • 1775 patients were screened (216 high-risk patients for randomisation and 1559 low-risk participants for observation).

Primary outcome

  • The primary outcome was development of confirmed microalbuminuria in 2 of 3 first morning voids urine samples with at least a 30% increase from run-in samples or 40 mg/g.
  • Mean follow-up was for 2.57 years (range 7 days - 4.33 years).
  • Development of confirmed microalbuminuria occurred in 28.2% of high-risk patients and in 8.9% of low-risk participants (P <0.0001).
  • The cumulative risk of persistent microalbuminuria was significantly greater in the high-risk group (HR 2.48; 95% CI 1.796-3.424; P <0.0001).
  • Spironolactone did not prevent progression to microalbuminuria in CKD273 high-risk patients with normoalbuminuria compared to placebo.
  • Spironolactone treatment increased the risk of progression to stage 3 chronic kidney disease compared to placebo.
  • In patients with type 2 diabetes and normoalbuminuria, the urinary proteomic classifier CKD273 predicts progression to microalbuminuria.
  • Spironolactone does not prevent progression to microalbuminuria in high-risk subjects.

Key messages/Clinical Perspectives

  • CKD273 may be useful to predict a decline in renal function, and may be of benefit in routine management.

 

Trial: NCT02040441




Presenter disclosure: The presenters has reported that no relationships exist relevant to the contents of this presentation.

Medical writer: Patrick Moore, PhD

Reviewer: Marco Gallo, MD

Local reviewers: Marco Gallo, MD (Italia); Anna Novials Sardá, MD, PhD (España); Eric Renard, MD, PhD (France); Peter Schwarz, MD, PhD (Deutschland) 

Scientific Editor: Florian Toti, MD


CLINICAL TRIALS

T2D & NEPHROPATY

CREDENCE – Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

Presented by: Carol Pollock, MBBS, PhD, FRACP, AAHMS; Hiddo Lambers Heerspink, PharmD, PhD; Kenneth W. Mahaffey, MD

PREVENTION

Results from the Anti-CD3 mAb (teplizumab) prevention trial

Presented by: Kevan Herold, MD; Peter S. Linsley, PhD

DIABETES & CVD

DECLARE study: call for action

Presented by: Itamar Raz, MD; Ofri Mosenzon, MD, MSc; Avivit Cahn, MD

T2D TREATMENT

VERIFY – Vildagliptin Efficacy in combination with metfoRmIn For earlY treatment of type 2 diabetes

Presented by: Chantal Mathieu, MD; Michael Stumvoli, MD; David R. Matthews, MD; Stefano del Prato, MD

DIABETES & HF

DAPA-HF: dapagliflozin and prevention of adverse-outcomes in heart failure

Presented by: Mikhail Kosiborod, MD; Silvio Inzucchi, MD

CV SAFETY

Results and implications of CAROLINA (CARdiOvascular Safety of LINAgliptin) comparing linagliptin vs glimepiride

Presented by: Julio Rosenstock, MD; Mark A. Espeland, MD; Steven E. Kahn, MD; Nikolaus Marx, MD; Bernard Zinman, MD; Darren McGuire, MD

T2D & CV PREVENTION

T1D DETERMINANTS

The Environmental Determinants of Diabetes in the Young (TEDDY) study

Presented by: Anette-Gabriele Ziegler, MD; Heikki Hyöty, MD, PhD
 

SYMPOSIA

NAFLD & DIABETES

EASD/EASL Symposium: is NAFLD a risk for health in the context of diabetes?

Presented by: Michael Roden, MD; Stefano Romeo, MD; Elisabetta Bugianesi, MD, PhD

HF & T2D

EASD/ESC Symposium: heart failure in type 2 diabetes

Presented by: M. Louis Handoko, MD; Javed Butler, MD, MPH, MBA

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