Effects of dapagliflozin in patients with kidney disease, with and without heart failure
JJV McMurray, DC Wheeler, BV Stefánsson, N Jongs… - Heart Failure, 2021 - jacc.org
Heart Failure, 2021•jacc.org
Objectives The purpose of this paper was to investigate the effects of dapagliflozin in chronic
kidney disease (CKD) patients, with and without heart failure (HF). Background Patients with
CKD, with and without type 2 diabetes, were enrolled in the DAPA-CKD (Dapagliflozin and
Prevention of Adverse Outcomes in Chronic Kidney Disease) trial. Some patients had HF at
baseline. Methods A total of 4,304 participants were randomized to dapagliflozin 10 mg daily
or placebo. The primary composite endpoint was≥ 50% decline in estimated glomerular …
kidney disease (CKD) patients, with and without heart failure (HF). Background Patients with
CKD, with and without type 2 diabetes, were enrolled in the DAPA-CKD (Dapagliflozin and
Prevention of Adverse Outcomes in Chronic Kidney Disease) trial. Some patients had HF at
baseline. Methods A total of 4,304 participants were randomized to dapagliflozin 10 mg daily
or placebo. The primary composite endpoint was≥ 50% decline in estimated glomerular …
Objectives
The purpose of this paper was to investigate the effects of dapagliflozin in chronic kidney disease (CKD) patients, with and without heart failure (HF).
Background
Patients with CKD, with and without type 2 diabetes, were enrolled in the DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) trial. Some patients had HF at baseline.
Methods
A total of 4,304 participants were randomized to dapagliflozin 10 mg daily or placebo. The primary composite endpoint was ≥50% decline in estimated glomerular filtration rate, end-stage kidney disease, or kidney/cardiovascular death. Secondary endpoints were a kidney composite (primary endpoint minus cardiovascular death), the composite of cardiovascular death/HF hospitalization, and all-cause death. Analysis of outcomes according to HF history was prespecified.
Results
HF patients (n = 468; 11%) were older and had more coronary disease, atrial fibrillation, and type 2 diabetes. Mean estimated glomerular filtration rate was similar in patients with and without HF. Rates of HF hospitalization/cardiovascular death and death from any cause were higher in HF patients, but the secondary kidney failure outcome occurred at the same rate in people with and without HF. Dapagliflozin reduced the risk of the primary outcome equally in patients with HF (HR: 0.58 [95% CI: 0.37-0.91]) and without HF (HR: 0.62 [95% CI: 0.51-0.75]) (P interaction = 0.59). The proportional risk-reductions were similar in patients with and without HF for the cardiovascular death/HF hospitalization composite (HR: 0.68 [95% CI: 0.44-1.05] vs HR: 0.70 [95% CI: 0.51-0.97], respectively; P interaction = 0.90), and all-cause death (HR: 0.56 [95% CI: 0.34-0.93] vs HR: 0.73 [95% CI: 0.54-0.97], respectively; P interaction = 0.39), although absolute risk reductions were larger in HF patients. Adverse event rates were low and did not differ among patients with or without HF.
Conclusions
Dapagliflozin reduced the risk of kidney failure and cardiovascular death/HF hospitalization and prolonged survival in CKD patients with or without type 2 diabetes, independently of history of HF. (A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients With Chronic Kidney Disease [DAPA-CKD]; NCT03036150)
jacc.org