![]() In addition, whether the KDIGO CKD classification can be used to identify patients who may derive greater absolute benefit from dapagliflozin, or whether there are subpopulations without such benefits, has not been determined, but may guide treatment decisions in clinical practice. Whether the clinical benefits of the SGLT2 inhibitor dapagliflozin in patients with CKD are generalisable to patients at various stages of CKD as defined by baseline KDIGO classification is unknown. The inclusion of both albuminuria and eGFR in the KDIGO CKD classification system allows cardiovascular and kidney risk categorisation based on combined albuminuria and eGFR assessment. Higher albuminuria and lower eGFR are well-established predictors of kidney failure and cardiovascular events, and form the foundation of the Kidney Disease Improving Global Outcomes (KDIGO) CKD disease classification system. The Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial extended these findings to a broader population of patients with CKD, with or without type 2 diabetes, and the results were independent of the degree of glycaemic control. The Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation (CREDENCE) trial demonstrated these clinical benefits in patients with type 2 diabetes and CKD. However, several clinical trials demonstrated that SGLT2 inhibitors prevent progression of chronic kidney disease (CKD), kidney failure, and cardiovascular events in patients with CKD. Due to the lack of glycaemic efficacy, it was assumed that SGLT2 inhibitors would not prevent micro- and macrovascular complications in patients with diabetes and reduced eGFR. Previous studies showed that the HbA 1c-lowering efficacy of SGLT2 inhibitors is attenuated or absent in patients with reduced eGFR. Sodium–glucose cotransporter 2 (SGLT2) inhibitors were originally developed as oral glucose-lowering drugs. The consistent benefits of dapagliflozin on kidney and cardiovascular outcomes across KDIGO risk categories indicate that dapagliflozin is efficacious and safe across a wide spectrum of kidney disease severity. The relative frequencies of adverse events and serious adverse events were also similar across KDIGO risk categories. Analysing patients with and without type 2 diabetes separately, the relative risk reduction with dapagliflozin in terms of the primary outcome was consistent across subgroups of KDIGO risk categories. Absolute risk reductions for the primary outcome were also consistent irrespective of KDIGO risk category ( p for interaction 0.26). MethodsĭAPA-CKD was a double-blind, placebo-controlled trial that randomised patients with an eGFR of 25–75 ml min −1 −2 and urinary albumin/creatinine ratio (UACR) of ≥22.6 and 0.09). In this post hoc analysis, we assessed the efficacy and safety of dapagliflozin according to baseline Kidney Disease Improving Global Outcomes (KDIGO) risk categories. ![]() Patients with more severe CKD are at higher risk of kidney failure, cardiovascular events and all-cause mortality. In the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, dapagliflozin reduced the risks of progressive kidney disease, hospitalised heart failure or cardiovascular death, and death from all causes in patients with chronic kidney disease (CKD) with or without type 2 diabetes. Effect of dapagliflozin on kidney and cardiovascular outcomes by baseline KDIGO risk categories: a post hoc analysis of the DAPA-CKD trial ![]()
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