DAPA-CKD: SGLT2 Inhibitor Benefit Extends to Chronic Kidney
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In the DAPA-CKD trial, treatment with the SGLT2 inhibitor dapagliflozin reduced risk for worsening renal function and death due to CVD or renal disease in patients with chronic kidney disease, both with and without type 2 diabetes, researchers reported at the virtual ESC 2020 Congress.

The DAPA-CKD trial enrolled 4304 patients with albuminuria based on having a urinary albumin-to-creatinine ratio of at least 200 mg/g and an eGFR of 25 to 75 mL/min per 1.73 m2 (with 90% of patients having an eGFR less than 60 mL/min per 1.73 m2), and 97% were receiving treatment with a renin-angiotensin system–blocking drug.

During a median follow-up of 2.4 years, the primary composite endpoint of worsening renal function — defined as at least a 50% sustained decline in estimated glomerular filtration rate or onset of end-stage renal disease — or death due to renal disease or CVD was reduced by 39% with dapagliflozin 10 mg (Farxiga, AstraZeneca) compared with placebo. Authors reported 197 primary endpoint events in the dapagliflozin group vs. 312 events in the placebo group.

More than 67% of patients in DAPA-CKD had diabetes at baseline. The effect of dapagliflozin on the primary endpoint was consistent in patients both with and without type 2 diabetes. The effects were also consistent in prespecified subgroup analyses based on urinary albumin creatinine ratio and eGFR at baseline.

In addition, dapagliflozin reduced all three secondary endpoints compared with placebo:

-- 44% reduction in worsening renal function or death from renal failure.
-- 31% reduction in all-cause mortality.
-- 29% reduction in HF hospitalization or CV death.

In addition, dapagliflozin also significantly reduced the prespecified clinically meaningful and patient-oriented endpoint of chronic dialysis, kidney transplantation or renal death.

This experience should give clinicians greater confidence about using dapagliflozin and other drugs in the SGLT2 inhibitor class in patients with substantially depressed renal function, researchers said.

Source: https://www.medscape.com/viewarticle/936550
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