Cited by 56Chronic Kidney Disease and DiabetesAcute Kidney Injury ResearchBlood Pressure and Hypertension Studies

Acute Increases in Serum Creatinine After Starting Angiotensin-Converting Enzyme Inhibitor-Based Therapy and Effects of its Continuation on Major Clinical Outcomes in Type 2 Diabetes Mellitus: The ADVANCE Trial

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Ohkuma, Toshiaki, Jun, Min, Rodgers, Anthony, Cooper, Mark E., Glasziou, Paul, Hamet, Pavel, Harrap, Stephen, Mancia, Giuseppe +9 more·2019·Hypertension

Abstract

Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creatinine are unclear. In the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), 11 140 diabetes mellitus patients were randomly assigned to perindopril-indapamide or placebo after a 6-week active run-in period. The current study included 11 066 participants with 2 serum creatinine measurements recorded before and during the active run-in period (3 weeks apart). Acute increase in creatinine was determined using these 2 measurements and classified into 4 groups: increases in serum creatinine of <10%, 10% to 19%, 20% to 29%, and ≥30%. The primary study outcome was the composite of major macrovascular events, new or worsening nephropathy, and all-cause mortality. An acute increase in serum creatinine was associated with an elevated risk of the primary outcome ( P for trend <0.001). The hazard ratios were 1.11 (95% CI, 0.97–1.28) for those with an increase of 10% to 19%, 1.34 (1.07–1.66) for 20% to 29%, and 1.44 (1.15–1.81) for ≥30%, compared with <10%. However, there was no evidence of heterogeneity in the benefit of randomized treatment effects on the outcome across subgroups defined by acute serum creatinine increase ( P for heterogeneity=0.94). Acute increases in serum creatinine after starting perindopril-indapamide were associated with greater risks of subsequent major clinical outcomes. However, the continuation of angiotensin-converting enzyme inhibitor-based therapy reduced the long-term risk of major clinical outcomes, irrespective of acute increase in creatinine. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00145925.

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Crossref · 10.1161/hypertensionaha.118.12060

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  • Epidemiologic data suggest no evidence of a threshold for adverse outcomes with a BP level below 115/75 mm Hg.

    “Epidemiologic data suggest no evidence of a threshold for adverse outcomes with a BP level <115/75 mm Hg.200”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [200]

    The Discussion (p. 6) addresses serum-creatinine changes after ACE inhibitor-based therapy, not an epidemiologic blood-pressure threshold. Searches for the 115/75 mm Hg threshold and for a blood-pressure threshold linked to adverse outcomes found no passage in our copy addressing the claim. (LLM, conf=0.76)

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  • Intensive glycemic control using insulin lowers the risk of microvascular and macrovascular complications in type 1 diabetes.

    “Intensive glycemic control with insulin therapy reduces the risk of these complications.200,1122,1123”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [200]

    The Study Design and Population section (p. 3) describes intensive glucose control in people with type 2 diabetes using a gliclazide-based regimen, not insulin treatment in type 1 diabetes. The Perspectives section (p. 8) reports benefits of continuing ACE inhibitor–based therapy, not the claimed effect of intensive insulin therapy. Searches for type 1 diabetes, insulin, and microvascular and macrovascular outcomes found no passage addressing the claim. (LLM, conf=0.75)

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  1. [2]2. American Diabetes Association. Standards of medical care in diabetes-2018. Diabetes Care . 2018;41:S1-S159.

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Authors
Ohkuma, T., Jun, M., Rodgers, A., Cooper, M. E., Glasziou, P., Hamet, P., Harrap, S., Mancia, G., Marre, M., Neal, B., Perkovic, V., Poulter, N., Williams, B., Zoungas, S., Chalmers, J., Woodward, M., & on behalf of the ADVANCE Collaborative Group
Affiliations
  • UNSW Sydney (AU)
  • Monash University (AU)
  • Bond University (AU)
  • Centre Hospitalier de l’Université de Montréal (CA)
  • The Royal Melbourne Hospital (AU)
  • University of Milan (IT)
  • Hôpital Bichat-Claude-Bernard (FR)
  • Imperial College London (GB)
  • UCL Biomedical Research Centre (GB)
  • Johns Hopkins University (US)
Corresponding author
Rodgers, Anthony
Venue
Hypertension
Published
2019-01
Volume
73
Issue
1
Pages
84-91
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
OpenAlex
W2901992834
Cited by
56
References
20
Citations by year
2026: 2 · 2025: 4 · 2024: 8 · 2023: 3 · 2022: 12 · 2021: 11 · 2020: 10 · 2019: 6
FWCI
5.49
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • Monash University Research Portal (Monash University) (submittedVersion, other-oa)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • BOA (University of Milano-Bicocca) (submittedVersion)
  • Bond University Research Portal (Bond University) (submittedVersion, other-oa)
  • Spiral (Imperial College London) (submittedVersion)
Funders
  • Amgen (1080206)
  • National Institute for Health and Care Research
  • University of New South Wales
  • Servier
  • Medical Research Council (MC_PC_13090)
  • National Health and Medical Research Council (1080206)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
ACE inhibitors, perindopril/indapamide, type 2 diabetes, diabetic nephropathy, all-cause mortality, ADVANCE trial, renin-angiotensin system blockade
MeSH terms
Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, Cardiovascular Diseases, Creatinine, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Drug Combinations, Female, Humans, Indapamide, Male, Middle Aged, Treatment Outcome, Drug Monitoring, Risk Assessment, Perindopril, Withholding Treatment, Medication Therapy Management

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