[OP.5A.03] NOVEL STRATEGIES TO IMPROVE THE MANAGEMENT OF ALBUMINURIA IN HYPERTENSIVE DIABETIC PATIENTS.
Bibliographic record
Abstract
Objective: After progressing with identification of genomic determinants of diabetic nephropathy, we evaluated the management of microalbuminuria in hypertensive patients with type 2 diabetes (T2D). Design and method: Clinical Practice in Diabetes Study (NCT01907958) is a multicenter stepped wedge cluster randomized trial of family practice clinics comparing the effect of introducing a Point of Care Testing (POCT) for urine albumin to usual practice in hypertensive patients with T2D and genetic testing in general practice. A total of 8 sites were involved, totaling 244 patients with uncontrolled hypertension followed for a period of 18 months. Sites were randomized to implement POCT sequentially. Results: At entry, 40% of patients were found to have albuminuria and 72% to have HbA1c > 6.5%. Albumin/creatinine ratio correlated with systolic blood pressure (SBP) (r = 0.113, p-value = 0.015) and HbA1c (r = 0.22, p-value = 0.001). SBP was not statistically different between microalbuminuric and normoalbuminuric patients (144 mmHg for both, p-value = 0.92) and HbA1c (7.3 for both, p-value = 0.89), suggesting that microalbuminuria cannot be predicted from uncontrolled BP or HbA1c without its direct measurement. Introduction of POCT led to an increase in normoalbuminuric patients over the course of the study (from 55% to 67%) while the percentage of normoalbuminuric patients did not increase in the control group. More patients also reached the target BP of 130/80 mmHg in those exposed to POCT (54%) compared to controls (38%). Among those who had reached the target SBP, 77% were receiving a combination therapy that included an ACEI or an ARB. Gene expression analyses identified 301 differentially expressed genes between patients who progressed from normo- to micro- and from micro- to macro-albuminuria with 132 genes associated to kidney phenotypes. Conclusions: There is a need for improvement in diagnosis and management of albuminuria in hypertensive T2D patients. Implementation of a POCT for albuminuria increased the number of patients at target BP and normal albuminuria. High BP and HbA1c are poor indicators of kidney damage. Genetic markers that correlate with albuminuria in hypertensive patients with T2D should be considered as future biomarkers for treatment initiation.
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How this classification was reachedexpand
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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.129 | 0.015 |
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, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
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".