Impact of outcome adjudication in kidney disease trials: observations from the Study of Heart and Renal Protection (SHARP).

Autor:	Herrington WG; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK.; Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Harper C; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK., Staplin N; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK., Haynes R; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK.; Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Emberson J; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK., Reith C; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK., Hooi LS; Hospital Sultanah Aminah, Johor Bahru, Malaysia., Levin A; University of British Columbia, Vancouver, Canada., Wanner C; University Clinic of Würzburg, Würzburg, Germany., Baigent C; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK., Landray M; Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), University of Oxford, UK.; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, UK.
Jazyk:	angličtina
Zdroj:	Kidney international reports [Kidney Int Rep] 2023 Aug; Vol. 8 (8), pp. 1489-1495.
DOI:	10.1016/j.ekir.2023.05.008
Abstrakt:	Introduction: We aimed to assess opportunities for trial streamlining and the scientific impact of adjudication on kidney and cardiovascular outcomes in CKD. Methods: We analysed the effects of adjudication of ~2100 maintenance kidney replacement therapy (KRT) and ~1300 major atherosclerotic events (MAEs) recorded in SHARP. We first compared outcome classification before versus after adjudication, and then re-ran randomised comparisons using pre-adjudicated follow-up data. Results: For maintenance KRT, adjudication had little impact with only 1% of events being refuted (28/2115). Consequently, randomised comparisons using pre-adjudication reports found almost identical results (pre-adjudication: simvastatin/ezetimibe 1038 vs placebo 1077; risk ratio [RR] 0.95, 95%CI 0.88-1.04; post-adjudicated: 1057 vs 1084; RR=0.97, 95%CI 0.89-1.05). For MAEs, about one-quarter of patient reports were refuted (324/1275 [25%]), and reviewing 3538 other potential vascular events and death reports identified only 194 additional MAEs. Nevertheless, randomised analyses using SHARP's pre-adjudicated data alone found similar results to analyses based on adjudicated outcomes (pre-adjudication: 573 vs 702; RR=0.80, 95%CI 0.72-0.89; adjudicated: 526 vs 619; RR=0.83, 95%CI 0.74- 0.94), and also suggested refuted MAEs were likely to represent atherosclerotic disease (RR for refuted MAEs=0.80, 95%CI 0.65-1.00). Conclusions: These analyses provide three key insights. First, they provide a rationale for nephrology trials not to adjudicate maintenance KRT. Secondly, when an event that mimics an atherosclerotic outcome is not expected to be influenced by the treatment under study (e.g. heart failure), the aim of adjudicating atherosclerotic outcomes should be to remove such events. Lastly, restrictive definitions for the remaining suspected atherosclerotic outcomes may reduce statistical power.
Databáze:	MEDLINE
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