Studies have shown that diabetes drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors can provide kidney- and cardiovascular-related benefits to individuals with or without diabetes and with or without impaired kidney function. An analysis appearing in an upcoming issue of JASN now provides insights about the efficacy and safety of SGLT2 inhibitors in people with advanced chronic kidney disease (CKD), an especially vulnerable population.
For the analysis, Glenn M. Chertow, MD, MPH (Stanford University School of Medicine) and his colleagues examined data from the Dapagliflozin And Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, which enrolled patients with and without type 2 diabetes and with mildly decreased to severely decreased kidney function (stage 4 CKD).
In DAPA-CKD, 624 of 4,304 (14%) patients had stage 4 CKD—with an estimated glomerular filtration rate (eGFR), a measure of kidney function, as low as 25 mL/min/1.73 m2—at the start of the study. Patients were randomized to receive daily treatments of the SGLT2 inhibitor dapagliflozin or placebo. Among patients with stage 4 CKD, those randomized to dapagliflozin experienced a 27% reduction in the primary endpoint (a composite of a sustained and large decline in kidney function, kidney failure, or death) and 29%, 17%, and 32% reductions in the kidney, cardiovascular, and mortality endpoints, respectively, compared with those randomized to placebo. Rates of serious side effects were similar in the two groups.
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