Dapagliflozin reduces the risk for hospitalization among patients with nondialysis-dependent chronic kidney disease, a new analysis confirms.
In a post hoc analysis of the DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) trial, 10 mg once daily dapagliflozin treatment significantly reduced the risk of a first hospitalization by 16% and all hospitalizations by 21%, compared with placebo, Hiddo J.L. Heerspink, PhD, of the University of Groningen in the Netherlands, and colleagues reported in the Annals of Internal Medicine.
Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, significantly reduced the rate of hospitalizations due to cardiac disorders by 33%, renal and urinary disorders by 39%, metabolism and nutrition disorders (such as electrolyte and acid-base disturbances) by 39%, and neoplasms by 38%.
The intervention was significantly associated with fewer mean days in the hospital (2.3 vs 2.8 days) and more hospital-free days (354.9 vs 351.7 days) per patient, the investigators reported.
“These findings highlight additional benefits of dapagliflozin beyond those seen for cardiovascular and kidney events, all-cause and cause-specific mortality, eGFR slope, and albuminuria and should be considered when evaluating the totality of evidence favoring provision of dapagliflozin to patients with CKD,” Dr Heerspink’s team wrote.
The post hoc analysis included 4304 adult patients (mean age 61.8 years; 33.1% women) from 386 ambulatory practice sites in 21 countries. Patients had an estimated glomerular filtration rate (eGFR) of 25 to 75 mL/min/1.73 m2 and a urinary albumin to creatinine ratio (UACR) of 200 to 5000 mg/g, with and without type 2 diabetes. Unless contraindicated, patients received a stable dose of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocker. The investigators observed a reduction in hospitalization risk across baseline eGFR and UACR categories and regardless of type 2 diabetes status.
Immunotherapy recipients and patients with type 1 diabetes, polycystic kidney disease, lupus nephritis, and antineutrophil cytoplasmic antibody-associated vasculitis were excluded from the DAPA-CKD trial.
As this is a post hoc analysis, the investigators cautioned that the results are hypothesis-generating.
Schechter M, Jongs N, Chertow GM, et al. Dapagliflozin reduces risk for hospitalization in patients with CKD with or without diabetes: a post hoc analysis of DAPA-CKD. Ann Intern Med. Published online December 5, 2022. doi:10.7326/M22-2115