Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure
Bibliographic record
Abstract
(2001) N Engl J Med 345, 861. Brenner BM, Cooper ME, de Zeeuw D, et al, for the RENAAL Study Investigators. . Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. . Sep 20; . : . –9 . [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTION: In patients with type 2 diabetes mellitus and nephropathy, what is the renoprotective effect of the angiotensin II receptor antagonist (ARA) losartan? Randomised (allocation concealed*), blinded (clinicians, patients, outcome assessors, and statisticians),* placebo controlled trial with mean follow up of 3.4 years (the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan [RENAAL] Study). 250 centres worldwide. 1513 patients between 31 and 70 years of age (mean age 60 y, 63% men) who had type 2 diabetes and nephropathy defined as a urinary albumin : creatinine ratio ≥ 300 mg/g and a serum creatinine concentration between 115 and 265 μmol/l (≥ 133 μmol/l for men weighing > 60 kg). Exclusion criteria included type 1 diabetes and non-diabetic renal disease. Follow up was 99.8%. After stratification by baseline level of proteinuria, patients were allocated to receive losartan, 50 to 100 mg/day (n=751), or placebo (n=762). Conventional antihypertensive treatment (excluding angiotensin I converting enzyme inhibitors and ARAs) was adjusted to target a systolic and diastolic blood pressure < 140 and < 90 mm Hg, respectively. The primary outcome was the composite of a doubling of the baseline serum creatinine concentration, end stage renal disease (ESRD), or death. The secondary outcome was the composite of cardiovascular morbidity or mortality. Analysis was by intention to treat. Losartan reduced the risk for the primary composite outcome (unadjusted p=0.02; p=0.03 after adjustment … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DBrenner%26rft.auinit1%253DB.%2BM.%26rft.volume%253D345%26rft.issue%253D12%26rft.spage%253D861%26rft.epage%253D869%26rft.atitle%253DEffects%2Bof%2BLosartan%2Bon%2BRenal%2Band%2BCardiovascular%2BOutcomes%2Bin%2BPatients%2Bwith%2BType%2B2%2BDiabetes%2Band%2BNephropathy%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa011161%26rft_id%253Dinfo%253Apmid%252F11565518%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa011161&link_type=DOI [3]: /lookup/external-ref?access_num=11565518&link_type=MED&atom=%2Febmed%2F7%2F3%2F82.atom [4]: /lookup/external-ref?access_num=000171039600002&link_type=ISI
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Other design | high |
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".