Dapagliflozin in Patients with Chronic Kidney Disease
The effect of dapagliflozin in preventing the decline of kidney function in patients with or without diabetes is yet unknown. Heerspink and colleagues (2020) have conducted a Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial to study “Effect of Dapagliflozin in Patients with Chronic Kidney Disease” published in The New England Journal of Medicine. Below is the summary of the proposed study:
Objective:
To assess the potential effect and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin in chronic kidney disease patients, with or without type 2 diabetes.
Method:
4,304 participants with glomerular filtration rate (GFR) of 25-75 ml per minute per 1.73 m2 of the body surface area and the urinary albumin-to-creatinine ratio of 200-5000 were included. The participants were randomly assigned with dapagliflozin (10 mg once daily) and placebo.
Findings:
The study reported a lower risk of decline in GFR by 50%, end-stage renal disease, death from the cardiovascular or renal cause in participants receiving dapagliflozin than placebo. This adds to background therapies that include angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for patients with chronic kidney disease with or without diabetes. The study confirms a new treatment approach with SGLT2 inhibitors in chronic kidney disease patients without diabetes. This finding is of utmost importance as the only pharmacological treatment for the prevention of kidney failure was shown with angiotensin-converting enzyme (ACE) inhibitors until now in this population. Cases of diabetic ketoacidosis and hypoglycemic episode were not reported in patients receiving dapagliflozin.
Limitations:
On basis of a recommendation from the independent data monitoring committee, this trial was terminated before completion. This might have reduced the secondary outcomes of the study. The inability to collect GFR after completion of the study has limited the findings, study reports.
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