Evidence mapPaperPMID 38816205Full record

ArticleBMJ open diabetes research & care2024

Plasma angiotensin-converting enzyme 2 (ACE2) is a marker for renal outcome of diabetic kidney disease (DKD) (U-CARE study 3).

Asami Ueno, Yasuhiro Onishi, Koki Mise, Satoshi Yamaguchi, Ayaka Kanno, Ichiro Nojima, Chigusa Higuchi, Haruhito A Uchida, Kenichi Shikata, Satoshi Miyamoto and 16 more

Abstract read
In one paragraph

Article in BMJ open diabetes research & care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Asami UenoOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Yasuhiro OnishiOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Koki MiseOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Satoshi YamaguchiOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Ayaka KannoOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Ichiro NojimaOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Chigusa HiguchiOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Haruhito A UchidaOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Kenichi ShikataOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Satoshi MiyamotoOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Atsuko NakatsukaOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Jun EguchiOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Kazuyuki HidaDepartment of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Akihiro KatayamaDepartment of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, Okayama, Japan.ORCID 0000-0002-9729-7343
Mayu WatanabeDepartment of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Tatsuaki NakatoDepartment of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan.
Atsuhito ToneDepartment of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan.
Sanae TeshigawaraOkayama Saiseikai General Hospital, Okayama, Japan.
Takashi MatsuokaDepartment of Diabetic Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
Shinji KameiDepartment of Diabetic Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
Kazutoshi MurakamiDepartment of Diabetic Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
Ikki ShimizuSakakibara Heart Institute of Okayama, Okayama, Japan.
Katsuhito MiyashitaJapanese Red Cross Okayama Hospital, Okayama, Japan.
Shinichiro AndoOkayama City General Medical Center, Okayama, Japan.
Tomokazu NunoueNunoue Clinic, Tsuyama, Japan.
Jun WadaOkayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan junwada@okayama-u.ac.jp.ORCID 0000-0003-1468-5170

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionACE cleaves angiotensin I (Ang I) to angiotensin II (Ang II) inducing vasoconstriction via Ang II type 1 (AT1) receptor, while ACE2 cleaves Ang II to Ang (1-7) causing vasodilatation by acting on the Mas receptor. In diabetic kidney disease (DKD), it is still unclear whether plasma or urine ACE2 levels predict renal outcomes or not. RESEARCH DESIGN AND

methodsAmong 777 participants with diabetes enrolled in the Urinary biomarker for Continuous And Rapid progression of diabetic nEphropathy study, the 296 patients followed up for 9 years were investigated. Plasma and urinary ACE2 levels were measured by the ELISA. The primary end point was a composite of a decrease of estimated glomerular filtration rate (eGFR) by at least 30% from baseline or initiation of hemodialysis or peritoneal dialysis. The secondary end points were a 30% increase or a 30% decrease in albumin-to-creatinine ratio from baseline to 1 year.

resultsThe cumulative incidence of the renal composite outcome was significantly higher in group 1 with lowest tertile of plasma ACE2 (p=0.040). Group 2 with middle and highest tertile was associated with better renal outcomes in the crude Cox regression model adjusted by age and sex (HR 0.56, 95% CI 0.31 to 0.99, p=0.047). Plasma ACE2 levels demonstrated a significant association with 30% decrease in ACR (OR 1.46, 95% CI 1.044 to 2.035, p=0.027) after adjusting for age, sex, systolic blood pressure, hemoglobin A1c, and eGFR.

conclusionsHigher baseline plasma ACE2 levels in DKD were protective for development and progression of albuminuria and associated with fewer renal end points, suggesting plasma ACE2 may be used as a prognosis marker of DKD. TRIAL REGISTRATION NUMBER: UMIN000011525.

Indexed as

Angiotensin-Converting Enzyme 2BiomarkersDiabetic NephropathiesGlomerular Filtration RateAgedDisease ProgressionFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisACE2 protein, humanAngiotensin-Converting Enzyme 2Biomarkersangiotensinsdiabetic neuropathiesobservational studyoutcome assessment, health care

Identifiers

PMID38816205
PMCPMC11141182

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