The DAPA-CKD trial, a landmark study, has provided significant insights into the effects of dapagliflozin, an SGLT2 inhibitor, on patients with chronic kidney disease (CKD) and albuminuria.
This study is particularly noteworthy as it includes patients with and without type 2 diabetes, thereby broadening the scope of its findings.
The trial involved 4 304 adults with an estimated glomerular filtration rate (eGFR) ranging from 25 to 75ml/min/1.73m² and a urinary albumin-to-creatinine ratio of 200 to 5 000mg/g. Participants were randomly assigned to receive either dapagliflozin 10mg or a placebo daily. The primary endpoint of the study focused on significant kidney decline, end-stage kidney disease, and kidney or cardiovascular death. Secondary endpoints included various kidney and cardiovascular outcomes and all-cause mortality.
A key aspect of the study was the requirement for participants to be on stable doses of renin-angiotensin-aldosterone system (RAAS) inhibitors. The study also categorised patients based on their use of other cardiovascular medications, allowing for a comprehensive analysis of dapagliflozin's effects across different patient profiles.
The results of the DAPA-CKD trial were compelling. Dapagliflozin significantly lowered the risk of adverse kidney and cardiovascular events compared to placebo, regardless of the concurrent use of cardiovascular medications. This finding is crucial as it suggests that dapagliflozin can be safely and effectively used in CKD patients, even those who are on various cardiovascular treatments. The safety profile of dapagliflozin remained consistent throughout the study, with no increase in serious adverse events reported.
The trial was conducted from February 2017 to June 2020 across 386 sites in 21 countries. The analysis showed that dapagliflozin consistently reduced the risk of both primary and secondary composite endpoints. Importantly, there were no significant differences in outcomes based on the use of cardiovascular medications, further supporting the broad applicability of dapagliflozin in managing CKD and associated cardiovascular issues.
The collaborative nature of the research is also highlighted in the document, with numerous contributors from various medical institutions worldwide. This global effort underscores the importance and impact of the study in the field of nephrology research.
Conclusion
In conclusion, the DAPA-CKD trial supports the use of dapagliflozin in CKD patients, demonstrating its compatibility with standard cardiovascular treatments and its potential benefits in managing kidney health. The findings of this study are likely to influence clinical practice, offering a new avenue for the treatment of CKD patients at higher risk of adverse kidney and cardiovascular events. The trial's comprehensive approach and robust results make a strong case for the inclusion of dapagliflozin in the therapeutic arsenal against chronic kidney disease.
Reference
Chertow GM, Correa-Rotter R, Vart P, Jongs N, et al. Effects of Dapagliflozin in Chronic Kidney Disease, With and Without Other Cardiovascular Medications: DAPA-CKD Trial. J Am Heart Assoc. 2023:2;12(9):e028739. doi: 10.1161/JAHA.122.028739. Epub 2023 Apr 29. PMID: 37119064; PMCID: PMC10227210.
