02862nas a2200265   4500000000100000008004100001100001500042700001400057700001700071700001800088700001900106700001400125700001400139700001600153700001700169700001600186700001900202700001500221245012500236250001500361300001200376490000700388520215200395020004902547       2010                            d1 aGrobbee D.1 aCass Alan1 aHeerspink H.1 aWoodward Mark1 aZoungas Sophia1 aMancia G.1 aCooper M.1 aMogensen C.1 aT. Ninomiya.1 aChalmers J.1 aPerkovic Vlado1 aNeal Bruce00aEffects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease  a2010/05/27  a2888-960 v313 a<p>
For more information about the Action in Diabetes and Vascular Disease Preterax and Diamicron MR Controlled Evaluation (ADVANCE) study <a href="/projects/action-in-diabetes-and-vascular-disease-preterax-and-diamicron-mr-controlled-evaluation">click here</a>.
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<h2>
Aims
</h2>

<p>
Individuals with diabetes and chronic kidney disease (CKD) are at high risk for cardiovascular disease. In these analyses of the ADVANCE trial, we assessed the effects of a fixed combination of perindopril-indapamide on renal and cardiovascular outcomes in patients with type 2 diabetes according to baseline CKD stage.
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<h2>
Methods and results
</h2>

<p>
Patients with type 2 diabetes were randomized to perindopril-indapamide (4 mg/1.25 mg) or placebo. Treatment effects on cardiovascular (cardiovascular death, myocardial infarction, or stroke) and renal outcomes were compared in subgroups defined by baseline Kidney Disease Outcome Quality Initiative CKD stage. Homogeneity in treatment effect was tested by adding interaction terms to the relevant Cox models. The study included 10 640 participants with known CKD status, of whom 6125 did not have CKD, 2482 were classified as CKD stage 1 or 2, and 2033 as CKD stage &gt;/=3. The relative treatment effects on major cardiovascular events were similar across all stages of CKD, with no heterogeneity in the magnitude of the effects for any outcome. In contrast, the absolute treatment effects approximately doubled in those with CKD stage &gt;/=3 when compared to those with no CKD. For every 1000 patients with CKD stage &gt;/=3 treated for 5 years, active treatment prevented 12 cardiovascular events when compared with six events per 1000 patients with no CKD.
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<h2>
Conclusion
</h2>

<p>
The treatment benefits of a routine administration of a fixed combination of perindopril-indapamide to patients with type 2 diabetes on cardiovascular and renal outcomes, and death, are consistent across all stages of CKD at baseline. Absolute risk reductions are larger in patients with CKD highlighting the importance of blood pressure-lowering in this population.
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  a1522-9645 (Electronic) - 0195-668X (Linking)