Effects of Dapagliflozin in Chronic Kidney Disease Across the Spectrum of Age and by Sex.
J Gen Intern Med
; 39(6): 921-930, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38097862
ABSTRACT
BACKGROUND:
The sodium-glucose cotransporter type 2 inhibitor dapagliflozin reduces the risk of progressive kidney disease and cardiovascular events in patients with chronic kidney disease, with and without type 2 diabetes. Whether its effects are uniform across the spectrum of age and among men and women is unknown.OBJECTIVE:
We performed a pre-specified analysis in DAPA-CKD to evaluate efficacy and safety of dapagliflozin according to baseline age and sex.DESIGN:
Prospective randomized placebo-controlled trial.PARTICIPANTS:
A total of 4304 adults with chronic kidney disease (estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.73 m2; urinary albumin-to-creatinine ratio 200-5000 mg/g) with and without type 2 diabetes. INTERVENTION Dapagliflozin 10 mg versus placebo once daily. MAINMEASURES:
Primary endpoint was a composite of ≥ 50% sustained eGFR decline, end-stage kidney disease, and kidney or cardiovascular death. Secondary endpoints included kidney composite endpoint (same as primary composite endpoint but without cardiovascular death), cardiovascular composite endpoint (hospitalized heart failure or cardiovascular death), and all-cause mortality. KEYRESULTS:
Median follow-up was 2.4 years. Absolute risks of cardiovascular composite endpoint and all-cause mortality were higher in older patients. Absolute risk of kidney composite endpoint was highest in patients < 50 years (10.7 and 6.2 per 100 patient-years in the placebo and dapagliflozin groups, respectively) and lowest in patients ≥ 80 years (3.0 and 1.2 per 100 patient-years in the placebo and dapagliflozin groups, respectively). There was no evidence of heterogeneity of the effects of dapagliflozin on the primary or secondary endpoints based on age or sex. Neither age nor sex modified the effects of dapagliflozin on total or chronic eGFR slope.CONCLUSIONS:
Dapagliflozin reduced the risks of mortality, cardiovascular events, and CKD progression in older patients, including in septuagenarians and octogenarians who comprised 25% of participants. Ageism and/or therapeutic nihilism should not discourage the use of dapagliflozin in older women and men who are likely to experience considerable benefit. TRIAL REGISTRY clinicaltrials.gov NIH TRIAL REGISTRY NUMBER NCT03036150.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Benzhydryl Compounds
/
Diabetes Mellitus, Type 2
/
Renal Insufficiency, Chronic
/
Sodium-Glucose Transporter 2 Inhibitors
/
Glucosides
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Gen Intern Med
/
J. gen. intern. med
/
Journal of general internal medicine
Journal subject:
MEDICINA INTERNA
Year:
2024
Type:
Article
Affiliation country:
United States