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Corresponding Author Dr Franz Shaefer; Germany
Background ,[object Object],[object Object],[object Object],[object Object],[object Object]
Effective BP Control  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MDRD Trial The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease Saulo Klahr, Andrew S. Levey, Gerald J. Beck, Arlene W. Caggiula, Lawrence Hunsicker, John W. Kusek, and Gary Striker for the Modification of Diet in Renal Disease Study Group N Engl J Med 1994; 330:877-884
Proteinuria: a marker and mechanism of progressive kidney disease ,[object Object],[object Object],[object Object]
AASK: African-American Study of Kidney Disease and Hypertension ,[object Object],[object Object],[object Object]
Research Question ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Study Design ,[object Object],[object Object]
To evaluate the antihypertensive, antiproteinuric and renoprotective efficacy of  fixed-dose ACE inhibition  in children with CKD stage II-IV To evaluate the renoprotective efficacy of  intensified blood pressure control , targeting to low- normal 24h BP, in children receiving fixed-dose ACE inhibition Main Objectives of ESCAPE Trial E S C A P E
E S C A P E   TRIAL E ffect   of S trict Blood Pressure   C ontrol and  A CE Inhibition on  P rogression   of Chronic Renal Failure in P E diatric Patients ,[object Object],[object Object]
Duration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Study Plan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Subjects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Premature Withdrawl ,[object Object],[object Object],[object Object],[object Object],[object Object]
Run-in period ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stratification and Randomisation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Measurements during the study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dose Adjustment ,[object Object],[object Object],[object Object]
Outcome Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Statistical Analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Statistical Analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Primary End Point ,[object Object],[object Object],[object Object]
Increased risk of reaching the primary end point ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Time to event analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Kaplan Meier Curves
 
Proteinuria and Progression ,[object Object],[object Object],[object Object],[object Object]
 
Updated version of Lewis and Ellis's original plot showing effect of β blockers on mortality. Lewis S , Clarke M BMJ 2001;322:1479-1480 ©2001 by British Medical Journal Publishing Group
Intervention group does better than control  OR = 1.0 (no effect) Intervention group does worse than control
i. Probably a small study, with a wide confidence interval, crossing the line of no effect (OR = 1). Unable to say if the intervention works
ii. Probably a small study, wide confidence interval , but does not cross OR = 1; suggests intervention works but weak evidence
iii. Larger study, narrow confidence interval: but crosses OR = 1; no evidence that intervention works
iv. Large study, narrow confidence intervals: entirely to left of OR = 1; suggests intervention works
v. Small study, wide confidence intervals, suggests intervention is detrimental
vi. Meta-analysis of all identified studies: suggests intervention works.
 
Secondary Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Outcomes ,[object Object],[object Object],[object Object],[object Object]
Target Mean BP reached ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Secondary Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Discussion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Comparison previous studies ,[object Object],[object Object],[object Object]
Late Proteinuria increase ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ET-1 TGF  UPCR ** ** * *** *** * *** **
Aldosterone Breakthrough ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Conclusions
Future Prospects ,[object Object],[object Object],[object Object],[object Object],[object Object]
Critical Appraisal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Strengths ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Escape

  • 1. Corresponding Author Dr Franz Shaefer; Germany
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  • 4. MDRD Trial The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease Saulo Klahr, Andrew S. Levey, Gerald J. Beck, Arlene W. Caggiula, Lawrence Hunsicker, John W. Kusek, and Gary Striker for the Modification of Diet in Renal Disease Study Group N Engl J Med 1994; 330:877-884
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  • 9. To evaluate the antihypertensive, antiproteinuric and renoprotective efficacy of fixed-dose ACE inhibition in children with CKD stage II-IV To evaluate the renoprotective efficacy of intensified blood pressure control , targeting to low- normal 24h BP, in children receiving fixed-dose ACE inhibition Main Objectives of ESCAPE Trial E S C A P E
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  • 34. Updated version of Lewis and Ellis's original plot showing effect of β blockers on mortality. Lewis S , Clarke M BMJ 2001;322:1479-1480 ©2001 by British Medical Journal Publishing Group
  • 35. Intervention group does better than control OR = 1.0 (no effect) Intervention group does worse than control
  • 36. i. Probably a small study, with a wide confidence interval, crossing the line of no effect (OR = 1). Unable to say if the intervention works
  • 37. ii. Probably a small study, wide confidence interval , but does not cross OR = 1; suggests intervention works but weak evidence
  • 38. iii. Larger study, narrow confidence interval: but crosses OR = 1; no evidence that intervention works
  • 39. iv. Large study, narrow confidence intervals: entirely to left of OR = 1; suggests intervention works
  • 40. v. Small study, wide confidence intervals, suggests intervention is detrimental
  • 41. vi. Meta-analysis of all identified studies: suggests intervention works.
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  • 54. ET-1 TGF  UPCR ** ** * *** *** * *** **
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Hinweis der Redaktion

  1. Updated version of Lewis and Ellis's original plot (fig 1) showing effect of β blockers on mortality