临床试验
医学
肾脏疾病
肾功能
肾脏替代疗法
内科学
肾病科
重症监护医学
临床意义
随机对照试验
作者
Dustin J. Little,Samvel B Gasparyan,Patrick Schloemer,Niels Jongs,Meike Brinker,Martin Karpefors,Christoph Tasto,Nicole Mentenich,Lars Frison,Richard Nkulikiyinka,Jérôme Rossert,Hiddo J.L. Heerspink
出处
期刊:Journal of The American Society of Nephrology
日期:2023-10-09
卷期号:34 (12): 1928-1935
标识
DOI:10.1681/asn.0000000000000244
摘要
Clinical trials in nephrology often use composite end points comprising clinical events, such as onset of ESKD and initiation of kidney function replacement therapy, along with a sustained large ( e.g. , ≥50%) decrease in GFR. Such events typically occur late in the disease course, resulting in large trials in which most participants do not contribute clinical events. In addition, components of the end point are considered of equal importance; however, their clinical significance varies. For example, kidney function replacement therapy initiation is likely to be clinically more meaningful than GFR decline of ≥50%. By contrast, hierarchical composite end points (HCEs) combine multiple outcomes and prioritize each patient's most clinically relevant outcome for inclusion in analysis. In this review, we consider the use of HCEs in clinical trials of CKD progression, emphasizing the potential to combine dichotomous clinical events such as those typically used in CKD progression trials, with the continuous variable of GFR over time, while ranking all components according to clinical significance. We consider maraca plots to visualize overall treatment effects and the contributions of individual components, discuss the application of win odds in kidney HCE trials, and review general design considerations for clinical trials for CKD progression with kidney HCE as an efficacy end point.
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