Dapagliflozin (Farxiga) used to be renoprotective and cardioprotective in sufferers with most causes of kidney disease with or without form 2 diabetes, a secondary analysis of the DAPA-CKD trial stumbled on.
In one more seek at the over 4,300 sufferers from the brand new trial, once-each day therapy with 10 mg of dapagliflozin vastly diminished the ache for the composite of a sustained decline in eGFR of 50% or more, stay-stage kidney disease, or demise from cardiovascular or kidney causes — the most main endpoint — regardless of the underlying reason in the support of kidney disease (hazard ratio [HR] 0.61, 95% CI 0.51-0.72), talked about David Wheeler, MD, of the George Institute for World Effectively being in Sydney, Australia, for the length of a presentation at the American Society of Nephrology’s virtual Kidney Week.
And when damaged down by etiology of kidney disease, dapagliflozin vastly diminished the ache for this composite most main endpoint in sufferers whose kidney disease used to be ended in by diabetic nephropathy (HR 0.63, 95% CI 0.51-0.78) and glomerulonephritides (HR 0.43, 95% CI 0.26-0.71) in contrast with placebo.
Nonetheless, sufferers whose kidney disease used to be ended in by ischemic/hypertensive continual kidney disease (CKD; HR 0.75, 95% CI 0.44-1.26) or ended in by other or unknown causes (HR 0.58, 95% CI 0.29-1.19) didn’t peep a most main wait on with dapagliflozin.
In an extra analysis of 270 sufferers with IgA nephropathy, there used to be a 71% diminished ache for this most main endpoint with dapagliflozin versus placebo over a 32-month follow-up period (HR 0.29, 95% CI 0.12-0.73).
“As we now non-public already viewed from this perceive in sufferers with continual kidney disease with and without form 2 diabetes, dapagliflozin diminished the ache of kidney failure, diminished the ache of demise from cardiovascular causes or hospitalization for heart failure, and prolonged survival,” Wheeler identified.
“On this pre-specified analysis, we now non-public shown that these renal-cardiovascular mortality advantages are modern regardless of the underlying reason in the support of continual kidney disease and regardless of the presence or absence of form 2 diabetes,” he well-known.
Similar findings were reported when fully taking a seek at renal-particular outcomes, defined as a sustained 50% or more eGFR decline, development to remain-stage kidney disease, or renal demise. Total, there used to be a 44% diminished ache for this consequence with dapagliflozin versus placebo (HR 0.56, 95% CI 0.45-0.68).
For those whose kidney disease used to be ended in by diabetic nephropathy, there used to be a 45% diminished ache for this composite renal consequence (HR 0.55, 95% CI 0.43-0.71), while those whose kidney disease used to be ended in by glomerulonephritides saw a 57% diminished ache for this renal consequence with dapagliflozin (HR 0.43, 95% CI 0.26-0.72).
Once more, sufferers whose kidney disease used to be namely ended in by ischemic or hypertensive CKD (HR 0.74, 95% CI 0.40-1.36) or other/unknown causes (HR 0.81, 95% CI 0.35-1.83) didn’t peep a most main diminished ache for this renal consequence with dapagliflozin versus placebo.
When taking a seek fully at cardiovascular outcomes, fully those whose kidney disease used to be ended in by diabetic nephropathy saw a vastly diminished ache for cardiovascular demise or hospitalization for heart failure with dapagliflozin (HR 0.67, 95% CI 0.50-0.90). Patients with all other underlying kidney disease etiologies didn’t peep a most main cardiovascular wait on.
In the connected vein, fully those with diabetic nephropathy saw a vastly diminished ache for all-reason mortality (HR 0.72, 95% CI 0.54-0.97).
One limitation to this perceive, on the opposite hand, used to be the exclusion of sufferers with form 1 diabetes, which Wheeler talked about used to be resulting from concerns about safety and the more than seemingly increased ache for diabetic ketoacidosis in this population.
All 4,304 participants in the DAPA-CKD trial had continual kidney disease with an eGFR of 25 to 75 mL/min/1.73m2 and a urine albumin-to-creatinine ratio of 200 to 5,000 mg/g.
The perceive used to be funded by AstraZeneca.
Wheeler reported relationships with University College London, Amgen, AstraZeneca, Boehringer Ingelheim, Janssen, Napp, Mundipharma, GlaxoSmithKline, Gilead, Tricida, Vifor Fresenius, Astellas, Merck Sharpe and Dohme, Ono Pharma, Reata, George Institute for World Effectively being, and the Kidney Effectively being Initiative. Other co-authors additionally reported disclosures.