Dapagliflozin reduces mortality and renal replacement in patients with chronic kidney disease

Référence

Heerspink HJL, Stefansson BV, Correa-Rotter R, et al, for the DAPA-CKD Trial Committees and Investigators. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020;383(15):1436-1446.

Sommaire

Dapagliflozin is an SGLT-2 inhibitor used to treat T2DM. Another drug in this class, canagliflozin, has been shown to improve renal and cardiovascular outcomes in patients with T2DM. The current industry-funded study identified adults with chronic kidney disease (estimated GFR 25 to 75 mL per minute per 1.73 m2 of body-surface area and a urinary albumin-to-creatinine ratio of 200 to 5000), all of whom were taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. At baseline, the patients' mean age was 62 years, 33% were women, the mean GFR was 43, 67.5% had T2DM, 38% had cardiovascular disease, and 11% had heart failure. The groups were balanced at baseline and analysis was by intention to treat. Patients were randomized to receive dapagliflozin 10 mg once daily or matching placebo and they were followed up for a median 2.4 years, with excellent retention (99.7%) in the trial. Fewer patients in the dapagliflozin group required chronic dialysis or underwent renal transplant (3.2% vs 4.6%; hazard ratio [HR] 0.66; 95% CI 0.49 - 0.90; NNT = 71 for 2.4 years). There was no significant difference between the groups in deaths from renal or cardiovascular causes, though all-cause mortality was lower in the dapagliflozin group (4.7% vs 6.8%; P = .004; NNT = 48 over 2.4 years). Adverse events were similar between groups. Results were similar for older and younger patients, by race, and whether or not the patient had T2DM.