Complex-case evidence review: CKD and low-albuminuria extrapolation
Real sources · Illustrative request · Sample version
Customer question
Illustrative situation: a case discussion asks about important kidney outcomes and whether evidence extends to a patient with low albuminuria.
P: CKD; I: dapagliflozin; C: placebo; O: the primary kidney/cardiovascular composite. Where is direct evidence for low ACR?
Show trial results and population boundaries together. DAPA-CKD albuminuria criteria cannot be omitted.
DAPA-CKD: primary composite event proportion
Real randomized trial; median follow-up 2.4 years, HR 0.61 (95% CI 0.51–0.72). Composite: sustained eGFR decline ≥50%, end-stage kidney disease, or kidney/cardiovascular death. Not an individual prediction for all CKD.
Analysis excerpt
| Check | Finding / sample content | Use |
|---|---|---|
| Direct population | Trial eGFR 25–75 and ACR 200–5000 mg/g | A lower-ACR case requires an explicit extrapolation check |
| Endpoint meaning | The chart is a composite, not kidney failure alone | Retain endpoint, denominator and time window |
| Unanswered items | This miniature example has not searched all low-ACR trials | A commission searches its agreed scope rather than asserting no evidence |
Delivery manifest
| File | Format | Contents |
|---|---|---|
| Case-evidence review brief example | PICO, search boundary, key sources, outcomes and applicability | |
| Priority evidence matrix | CSV | Population, denominators, results, direct/indirect relevance and open items |
This is an illustrative formal delivery manifest. This pack supplies an HTML report, CSV tables and a source register. Agree formal formats, quantities and scope in the quote.
Acceptance criteria
- Each question has support or is explicitly unanswered. Facts, original locations, applicability and review status are checkable. Preserve supporting, contrary and uncertain evidence; a definite recommendation or better outcomes is not an acceptance condition.
Sources
- DAPA-CKD randomized trial (NEJM, 2020; PMID 32970396)
https://pubmed.ncbi.nlm.nih.gov/32970396/