Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part B Therapy
Chapter 11.4. Surrogate Outcomes
Heiner C. Bucher, Regina Kunz, Deborah J. Cook, Anne Holbrook, Gordon Guyatt
We have found a strong, more or less consistent, independent, and biologically plausible...
Topics Discussed:
angiotensin receptor antagonists, angiotensin-converting enzyme inhibitors, cohort studies, diabetes mellitus, type 2, diabetic nephropathy, health outcomes, kidney failure, chronic, surrogate outcomes
Excerpt:
"We have found a strong, more or less consistent, independent,
and biologically plausible association between albuminuria and ESRD. Randomized
trials in AT-II receptor blockers have shown a consistent relationship
between decrease in albuminuria and ESRD in patients with type 2
diabetes. The evidence that ACE inhibitors reduce albuminuria
and ESRD in patients with type 2 diabetes is less strong, but trials
of ACE inhibitors in type 1 diabetes and nondiabetic renal disease
provide additional evidence of the link between reduction of albuminuria
and reduction of ESRD with ACE inhibitors. Although the case is
not as strong as it could be, we might reasonably conclude that
albuminuria is a surrogate marker that sufficiently fulfils our
criteria, and we may therefore use evidence based on the surrogate
marker to guide our decision whether to prescribe an ACE inhibitor
in this patient with type 2 diabetes to lower the risk of ESRD.
This evidence comes from the RCT that suggests that ACE
inhibitors are not inferior to AT-II receptor blockers in reducing
albuminuria but is limited by the wide CI...."
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