Ertugliflozin HF benefits differ based on kidney disease sev
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The HF benefits observed in adults with type 2 diabetes and atherosclerotic CVD treated with the SGLT2 inhibitor ertugliflozin were greater among those with moderate to high risk for kidney disease.

In exploratory analyses of the VERTIS-CV trial, the effect of ertugliflozin on hospitalization for HF and a composite endpoint of hospitalization for HF and CV death differed based on the severity of kidney disease parameters that included urinary to albumin creatinine ratio and estimated glomerular filtration rate (eGFR).

In prespecified exploratory analyses of VERTIS-CV, researchers assessed the effect of ertugliflozin on CV events by baseline levels of eGFR (CKD stage 1, 2 or 3), baseline urinary albumin to creatinine ratio (normal or elevated) and by baseline Kidney Disease Improving Global Outcomes CKD risk category (KDIGO CKD; low, moderate or high/very high risk). Analyses included testing of treatment group-by-subgroup interactions without adjustment for multiple testing.

The proportions of participants with CKD stages 1, 2, and 3 at baseline were 25%, 53% and 22%, respectively, whereas 60% and 40% of participants had normal and elevated albuminuria, respectively. Within the cohort, 49%, 32% and 19% were classified into the KDIGO CKD low-, moderate-, and high-/very high-risk categories, respectively.

Among participants with CKD stage 3 vs. placebo, researchers observed significant risk reduction for time to first hospitalization for HF and the composite of hospitalization for HF and CV death.

Researchers observed a similar benefit among participants with elevated urinary albumin-to-creatinine ratio for both hospitalization for HF and the composite HF and CV death endpoint.

There was also a similar benefit among participants in the KDIGO CKD moderate- and high-/very high-risk categories, with the highest absolute event rate reductions in these subgroups, the author said.

“A take-home message is that we need to measure urine albumin to risk-stratify patients, It is a potent way to identify patients at increased risk, as well as those who would derive the greatest benefit from SGLT2 inhibitors,” concluded researchers.

Source: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.051901
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