Effects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease.
OBJECTIVE
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.


RESULTS
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 ≥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 ≥3 when compared to those with no CKD. For every 1000 patients with CKD stage ≥3 treated for 5 years, active treatment prevented 12 cardiovascular events when compared with six events per 1000 patients with no CKD.


CONCLUSIONS
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.
Heerspink
Hiddo J Lambers
HJ
The George Institute for International Health, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
Ninomiya
Toshiharu
T
Perkovic
Vlado
V
Woodward
Mark
M
Zoungas
Sophia
S
Cass
Alan
A
Cooper
Mark
M
Grobbee
Diederick E
DE
Mancia
Giuseppe
G
Mogensen
Carl Eric
CE
Neal
Bruce
B
Chalmers
John
J
D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy; D007190:Indapamide / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D020913:Perindopril / Q000008:administration & dosage* / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D007190:Indapamide; D020913:Perindopril