Angiogenic factors versus fetomaternal Doppler for fetal growth restriction at term: an open-label, randomized controlled trial
Garcia-Manau P et al. Nature Medicine (January 2025)
Bottom Line: This randomized controlled trial compared the use of abnormal serum angiogenic factors, such as the soluble fms-like tyrosine kinase-1 (sFlt-1):placental growth factor (PlGF) ratio, with a traditional protocol of estimated fetal weight (EFW) and Doppler ultrasound in managing small fetuses with EFW below the 10th percentile after 36 weeks of gestation. A total of 1,088 pregnant patients were included in the study, with the primary outcome being neonatal acidosis or Cesarean delivery due to abnormal cardiotocography. The results showed that the sFlt-1:PlGF-based protocol was non-inferior to the traditional protocol, with an incidence of the primary outcomes of 10.5% in the intervention group and 10.0% in the control group (absolute difference, 0.53 [−3.21 to 4.26]). This suggests that the use of sFlt-1:PlGF may be a more accurate method for distinguishing between FGR and SGA, with fewer false positives. However, no information was provided on safety outcomes. In conclusion, the sFlt-1:PlGF-based protocol was found to be non-inferior to the traditional protocol in avoiding adverse perinatal outcomes in small fetuses after 36 weeks of gestation.
The effect of HbA1c variability on the efficacy of intensive blood pressure control in patients with type 2 diabetes
Wang X et al. Diabetes, Obesity & Metabolism (December 2024)
Bottom line: This retrospective analysis of data from the ACCORD-BP trial aimed to investigate the effect of HbA1c variability on the efficacy of intensive blood pressure control (SBP target < 120 mmHg) in patients with type 2 diabetes. The ACCORD-BP trial included 4733 high risk CVD participants with type 2 diabetes aged > 40 years with a systolic blood pressure (SBP) between 130 and 180 mmHg. This study used K-means clustering to group ACCORD-BP patients based on their HbA1c variability score and baseline HbA1c values. The primary outcome was a composite of nonfatal MI, stroke, or death from cardiovascular causes. On a relative scale, results showed that intensive blood pressure control was more effective in reducing the risk of the primary outcome in patients with low HbA1c variability compared to those with medium or high variability (HR 0.60, 95%CI 0.40–0.90, p interaction was 0.03). However, there was no significant difference in the risk of cardiovascular or all-cause mortality between the intervention and control groups. In conclusion, intensive blood pressure control may bring significant macrovascular benefits in patients with type 2 diabetes and low HbA1c variability.
Advancing Community Care and Access to Follow-Up after Acute Kidney Injury Hospitalization: A Randomized Clinical Trial (AFTER AKI)
Pannu N et al. JASN (March 2025)
Bottom Line: This randomized controlled trial conducted in Alberta, Canada, evaluated a risk-guided transition of care intervention for adults hospitalized with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI. A total of 155 participants with a mean age of 60 were recruited and randomized to either the risk-guided intervention group or usual care (control). In the intervention group, a validated risk index was used to predict risk of severe CKD after AKI. People at low risk (<1%) received patient education alone. People at medium risk received additional clinical guidance, provided to their primary care physician. People at high risk (>10%) were referred to nephrology. The primary outcome was the proportion of patients receiving ACE-I/ARB, statin treatment, and nephrologist follow-up within 90 days of discharge. The primary outcome occurred in 28% of the intervention group compared to 3% in usual care (absolute risk difference 25%; 95% CI, 15% to 36%). Safety outcomes indicated increased hyperkalemia in the intervention group. The study concluded that the intervention improved adherence to recommended care processes for CKD in high-risk AKI survivors.
Trial Files Issue #2025-09