Dapagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, is safe and effective in patients with advanced chronic kidney disease (CKD), according to a subgroup analysis of the DAPA-CKD trial.

For this study, researchers evaluated data from the Dapagliflozin And Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, which included 4304 patients with and without type 2 diabetes and stage 4 CKD. About 14% of patients had stage 4 CKD at baseline, with an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73m².

DAPA-CKD was a randomized, double-blind, placebo-controlled, multicenter clinical trial conducted in 21 countries.

Patients were randomly assigned to treatment with dapagliflozin (10 mg/day) or placebo. Compared to the placebo group, the dapagliflozin-treated group showed a 27% decline in the primary outcome, which was a composite of ≥50% sustained decline in kidney function, ESRD, or death in patients with advanced kidney disease. The risks of kidney and cardiovascular endpoints also reduced by 29% and 17%, respectively. All-cause mortality also declined by 32%. Rates of serious side effects were comparable between the two groups. Although the analysis did not include patients with baseline stage 5 CKD, it is pertinent to note that patients could continue with the treatment even when eGFR redeuced to <15 mL/min/1.73m2.

These beneficial effects of dapagliflozin were similar to those observed among patients with mild to moderate (stages 2/3) CKD. Since dapagliflozin was also beneficial in reducing the risk of major renal and cardiovascular events as well as mortality risk in patients with stage 4 CKD and albuminuria, with no evidence of increased adverse events, the study authors suggest that dapagliflozin should be considered in the management of patients with stage 4 CKD and albuminuria with or without type 2 diabetes.

Source: Chertwo G, et al. Effects of dapagliflozin in stage 4 chronic kidney disease. J Am Soc Nephrol. 2021 Jul 16;ASN.2021020167. doi: 10.1681/ASN.2021020167.

Dr Sanjay Kalra, DM, Bharti Hospital, Karnal;

Immediate Past President, Endocrine Society of India