Dapagliflozin reduces risk of hospitalization in adults with chronic kidney disease

Dapagliflozin, an SGLT2 inhibitor, was associated with a reduced risk of hospitalization from any cause in patients with chronic kidney disease with and without type 2 diabetes, according to a post hoc analysis of the DAPA-CKD test.

According to the manufacturer, AstraZeneca, previous data from the randomized, double-blind, placebo-controlled Phase 3 DAPA-CKD trial revealed an “overwhelming benefit” of dapagliflozin in adults with chronic kidney disease (CKD) . Treatment has been shown to reduce worsening kidney function or kidney mortality compared to placebo, regardless of patients’ diabetes status.

“Although cardiovascular and renal outcomes with SGLT2 inhibitors have been extensively studied, there are few data evaluating the effects of SGLT2 inhibitors on hospitalizations from any cause,” Meir Schechter, MD, PhD, a post-doctoral fellow at Hadassah Medical Center’s Diabetes Clinical Research Center in Israel, and his colleagues wrote in Annals of Internal Medicine.

For the current analysis, Schechter and colleagues examined data from 4,304 patients (mean age, 61.8 years; 33.1% female) with CKD to study the effects of dapagliflozin (10 mg once per day) versus placebo at first and subsequent hospitalizations.

Of the 2,906 participants with type 2 diabetes, 1,455 received dapagliflozin and 1,451 received a placebo. Among people without type 2 diabetes, 697 received dapagliflozin and 701 received a placebo.

Over a median follow-up period of 2.4 years, Schechter and colleagues identified 2,072 hospitalizations among 1,224 (28.4%) participants.

Dapagliflozin was associated with a lower risk of first hospitalization (HR=0.84; 95% CI, 0.75-0.94) and all hospitalizations (rate ratio [RR] = 0.79; 95% CI, 0.7-0.89) compared to placebo, according to the researchers. At least one hospitalization was reported in 26.3% of patients in the dapagliflozin group, representing an event rate of 143.7 per 1000 person-years, and 30.6% of patients in the placebo group, for an event rate of events of 171.9 events per 1,000 person-years. .

Schechter and colleagues further reported that, compared to placebo, dapagliflozin reduced the risk of hospitalizations due to cardiac disorders (RR=0.67; 95% CI, 0.53-0.86), renal and urinary disorders (RR=0.61; 95% CI, 0.46-0.79), metabolism and nutrition disorders (RR=0.61; 95% CI, 0.41-0, 91) and neoplasms (RR=0.62; 95% CI, 0.39-0.96).

“There was no evidence that the effects of dapagliflozin on first hospitalization and on all hospitalizations varied by the initial presence of type 2 diabetes,” they wrote.

Since the study was conducted as a post hoc analysis, Schechter and colleagues noted that it “should be viewed as hypothesis-generating.” Still, the researchers said the findings had “major clinical relevance” because hospitalizations contribute to the burden of CKD and reduce patients’ health-related quality of life.

“These results highlight additional benefits of dapagliflozin beyond those seen for cardiovascular and renal events, all-cause and cause-specific mortality, eGFR slope, and albuminuria and should be considered when considering ‘assessment of the totality of evidence supporting the provision of dapagliflozin to patients with CKD’, they wrote.