Effect of Kidney Disease in the ACCORD Trial

In the landmark ACCORD trial (NEJM JW Gen Med Jul 1 2008 and N Engl J Med 2008; 358:2545), which involved >10,000 patients with longstanding type 2 diabetes, all-cause and cardiovascular-related mortality were significantly higher in patients randomized to intensive glycemic control (target glycosylated hemoglobin [HbA_1c], <6%) than in those who received less-intensive control (target HbA_1c, 7.0%–7.9%). In this post-hoc analysis, researchers examined whether renal function influenced this outcome.

At baseline, 64% of participants had no chronic kidney disease (CKD), and 14%, 14%, and 8% had stage 1, 2, and 3 CKD, respectively (patients with more severe CKD were excluded). In the CKD group, intensively treated patients had significantly highe…