DAPA-CKD Study results in the context of preceding studies with gliflozins in the relation to chronic kidney disease


Authors: Ivan Tkáč
Authors‘ workplace: Excelentný tím pre výskum aterosklerózy (EXTASY), LF UPJŠ v Košiciach
Published in: Forum Diab 2021; 10(3): 218-221
Category:

Overview

The studies of cardiovascular safety studies with gliflozins have not only shown a benefit in reducing cardiovascular disease based mainly on their beneficial effect on heart failure, but have also suggested a possible benefit in preventing the progression of chronic kidney disease in patients with type 2 diabetes. As renal outcomes were monitored as a secondary outcome in these studies, it was necessary to conduct studies directly targeting patients with chronic kidney disease. The first such study with canagliflozin confirmed the benefit of this agent in preventing the progression of chronic kidney disease in patients with diabetic nephropathy. The aim of the DAPA-CKD study, which tested dapagliflozin, was not only to confirm the effect of gliflozin in patients with chronic kidney disease in diabetes, but also to observe whether this effect would also be present in subjects without diabetes The study showed that additive treatment with dapagliflozin led to a 29/1 000 patient-years (PR) reduction in the primary composite outcome and a 9/1 000 PR reduction in overall mortality. The effect was similar in both patients with type 2 diabetes and non-diabetic nephropathy. In addition, treatment with gliflozins has an additive effect to treatment with renin-angiotensin system inhibitors, which to date has been the only evidence-based treatment in preventing the progression of chronic kidney disease.

Keywords:

type 2 diabetes – chronic kidney disease – DAPA-CKD study – dapagliflozin –SGLT2 inhibitors


Sources

1. Zinman B, Wanner C, Lachin JM et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1504720>.
2. Neal B, Perkovic V, Mahaffey KW et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377(7): 644–657. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1611925>.
3. Wiviott SD, Raz I, Bonaca MP et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019; 380(4): 347–357. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1812389>.
4. McMurray JJV, Solomon SD, Inzucchi SE et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381(21): 1995–2008. Dostupné z DOI: <http://doi: 10.1056/NEJMoa1911303>.
5. Packer M, Anker SD, Butler J et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020; 383(15): 1413–1424. Dostupné z DOI: <http://doi: 10.1056/NEJMoa2022190>.
6. Cannon CP, Pratley R, Dagogo-Jack S et al. Cardiovascular outcomes with ertugliflozin in type 2 diabetes. New Engl J Med 2020; 383(15): 1425–1435. Dostupné z DOI: <http://doi: 10.1056/NEJMoa2004967>.
7. Bhatt DL, Szarek L, Pitt B et al. Sotagliflozin in patients with diabetes and chronic kidney disease. N Engl J Med 2021; 384(2): 129–139. Dostupné z DOI: <http://doi: 10.1056/NEJMoa2030186>.
8. Perkovic V, Jardine MJ, Neal B et al. [CREDENCE Trial Investigators]. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019; 380(24): 2295–2306. Dostupné z DOI: <http://doi:10.1056/NEJMoa1811744>.
9. Heerspink HJL, Stefánsson BV, Correa-Rotter R et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383(15): 1436–1446. Dostupné z DOI: <http://doi: 10.1056/NEJMoa2024816>.
10. Ferrannini E, Rosenstock J. Clinical translation of cardiovascular outcome trials in type 2 diabetes: Is there more or is there less than meets the eye? Diabetes Care 2021; 44(3): 641–646. Dostupné z DOI:<http://doi: 10.2337/dc20–0913>.
11. Wheeler DC, Stefánsson B, Jongs N et al. Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 2021; 9(1): 22–31. Dostupné z DOI: <http://doi: 10.1016/S2213–8587(20)30369–7>.
12. Cherney DZ, Odutayo A, Aronson R et al. Sodium glucose cotransporter-2 inhibition and cardiorenal protection. J Am Coll Cardiol 2019; 74(20): 2511–2524. Dostupné z DOI: <http://doi: 10.1016/j.jacc.2019.09.022>.

Labels
Diabetology Endocrinology Internal medicine
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