Dapagliflozin seen as safe for reducing adverse kidney outcomes in patients with CKD
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An analysis of data showed patients with chronic kidney disease and type 2 diabetes who were or were not prescribed mineralocorticoid receptor antagonists saw reductions in major adverse kidney outcomes after taking dapagliflozin.
“Mineralocorticoid receptor antagonists (MRAs) reduce albuminuria in patients with CKD, but clinical trials to establish their effects on major kidney outcomes were lacking until recently,” Hiddo J.L. Heerspink, PhD, and colleagues wrote. “The [Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease] DAPA-CKD trial enrolled patients treated with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and also allowed treatment with conventional MRAs (spironolactone and eplerenone). We report the efficacy and safety of dapagliflozin in patients with CKD who were or were not treated with MRAs in DAPA-CKD.”
Researchers from DAPA-CKD randomized the 229 of the 4,304 patients who were treated with conventional MRAs at baseline 1:1 to receive either dapagliflozin 10 mg (n=109) or placebo (n=120) once a day. A composite of at least 50% eGRF decline, end-stage kidney disease, or kidney or cardiovascular death was considered the primary outcome.
Proportional Cox hazard regression was used to measure dapagliflozin vs. placebo in patient subgroups.
Dapagliflozin did not have a significant impact on the primary outcome between groups, and its effect on hyperkalemia was similar among those prescribed and those not prescribed MRAs at baseline. Regardless of MRA prescription, adverse events were similar between treatment groups.
“In conclusion, in patients with CKD with and without type 2 diabetes, the effects of dapagliflozin in reducing the incidence of the primary composite and composite kidney endpoints, and of attenuating the decline in eGFR slope, were present in patients treated or not treated with MRAs at baseline,” Heerspink and colleagues wrote. “These findings support assessment of combination therapy with MRAs and SGLT2 inhibitors in future clinical trials.”
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