FO070LONG-TERM CARDIORENAL OUTCOMES ASSOCIATED WITH THE ACUTE INCREASE OF PLASMA CREATININE FOLLOWING RENIN-ANGIOTENSIN SYSTEM BLOCKADE IN A REAL-WORLD SETTING
Bibliographic record
Abstract
INTRODUCTION: The clinical significance of an acute rise in creatinine following initiation of renin-angiotensin inhibition (RASi) is unclear. The clinical significance of an acute rise in creatinine following initiation of renin-angiotensin inhibition (RASi) is unclear. METHODS: We performed a population-based retrospective analysis using the Stockholm CREAtinine Measurements (SCREAM) database, which contains complete information on diagnoses, medication dispensation claims, and laboratory test results for all Stockholm citizens accessing healthcare. We identified all adult new-users of RASi during 2007-2011 with pre- and post-initiation creatinine monitoring. Median follow up was 3.5 years. Cox regression was used to compare cardiorenal events among individuals with different ranges of creatinine increases within 2 months after starting treatment. Study outcomes considered death, heart failure, myocardial infarction and end-stage renal disease (ESRD). RESULTS: Out of 174,005 new users of RASi, 31,951 (18.1%) had adequate pre-/post-initiation monitoring. Of these, 7280 (22.8%) had acute creatinine increases of >10%. Creatinine increases were associated with death (3202 events): compared with creatinine increases <10%, a 10-19% increase showed adjusted HR 1.15 (95% CI 1.05-1.27); 20-29% increase, 1.22 (1.07-1.40); ≥30% increase, 1.55 (1.36-1.77). Similar associations were present for heart failure (2275 events) and ESRD (52 events; p values for trend <0.001), and, less consistently, myocardial infarction (842 events, p for trend 0.25). Results were robust across subgroups of patients, among continuing users, when participants with decreases in creatinine were excluded from the referent group, and after accounting for death as a competing risk. CONCLUSIONS: Among real-world monitored adults with acute increases in plasma creatinine of >10% following ACEi/ARB initiation, the higher the rise in plasma creatinine, the higher the risk of adverse cardiorenal outcomes. Closer monitoring of renal function and treatment of risk factors may be warranted in these individuals.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".