Baseline, Early Changes, and Residual Albuminuria: Post-hoc Analysis of a Clinical Trial of Dapagliflozin in Chronic Kidney Disease

蛋白尿 医学 肾脏疾病 肾功能 达帕格列嗪 内科学 2型糖尿病 析因分析 泌尿科 肌酐 糖尿病 临床终点 安慰剂 内分泌学 随机对照试验 病理 替代医学
作者
Dominique van Mil,Priya Vart,Glenn M. Chertow,Ron T. Gansevoort,Peter Rossing,Robert D. Toto,R Correa-Rotter,Anna Maria Langkilde,C. David Sjöström,David C. Wheeler,Hiddo J.L. Heerspink
出处
期刊:Clinical Journal of The American Society of Nephrology [Lippincott Williams & Wilkins]
卷期号:19 (12): 1574-1584
标识
DOI:10.2215/cjn.0000000000000550
摘要

Key Points Dapagliflozin reduced albuminuria in participants with CKD, with reductions being proportional to reductions in the risk of disease progression. Residual albuminuria (at month 4) was linked to higher risks of primary and kidney end points, with no heterogeneity by diabetes status or allocated treatment. Participants with residual albuminuria at month 4 had high rates of kidney end points, implying the need for added therapy for long-term kidney and cardiovascular benefits. Background Albuminuria is a strong indicator of kidney and cardiovascular risk in patients with CKD. We assessed risk associations between albuminuria at baseline and 4 months after randomization in a placebo-controlled trial of dapagliflozin and kidney end points in patients with CKD and albuminuria, with and without type 2 diabetes. Methods In this post hoc analysis of the dapagliflozin and prevention of adverse outcomes in CKD (DAPA-CKD) trial, 4304 adult patients with CKD were randomized to dapagliflozin 10 mg or placebo as an adjunct to maximally tolerated renin-angiotensin system inhibitors. The primary end point was a composite of sustained ≥50% decline in eGFR, kidney failure, or death from kidney or cardiovascular cause. The kidney composite end point was similar, but excluded cardiovascular death. We assessed associations among baseline albuminuria, early change in albuminuria (baseline to month 4), and residual albuminuria (month 4) with the primary composite and kidney composite end points using Cox proportional hazards regression analyses. Results Compared with placebo, dapagliflozin reduced urinary albumin–creatinine ratio (baseline to month 4) by 36.4% (95% confidence interval, 30.2% to 42.5%) and 20.5% (95% confidence interval, 11.6% to 29.5%) in participants with and without type 2 diabetes, respectively ( P -interaction: 0.02). A reduction in urinary albumin–creatinine ratio from baseline to month 4 was associated with a lower risk of the primary and kidney composite end points with a similar risk gradient for participants with and without type 2 diabetes ( P -interaction: 0.10 and 0.19, respectively). Residual albuminuria was associated with a similar risk of the primary and kidney composite end points in each treatment arm ( P -interaction: 0.19 and 0.18, respectively). Conclusions Dapagliflozin reduced albuminuria, and the magnitude of albuminuria reduction showed similar proportional reductions in risks of the primary and kidney composite end points in participants with and without type 2 diabetes. Participants with residual albuminuria at month 4—whether randomized to dapagliflozin or placebo—experienced relatively high rates of CKD progression kidney end points, suggesting that therapies added to renin-angiotensin system inhibitors and dapagliflozin may be required to sustain kidney and cardiovascular health. Clinical trial registry name and registration number: A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with CKD (DAPA-CKD), NCT03036150.

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
俭朴映阳发布了新的文献求助10
刚刚
刚刚
1秒前
单纯的亦云完成签到,获得积分20
1秒前
1秒前
SYLH应助FLZLC采纳,获得10
1秒前
内坻崿完成签到,获得积分10
1秒前
2秒前
2秒前
2秒前
2秒前
2秒前
倩倩发布了新的文献求助10
3秒前
欧阳振应助dan采纳,获得10
3秒前
5秒前
5秒前
ltt完成签到,获得积分10
5秒前
矫仁瑞完成签到,获得积分20
5秒前
6秒前
开心薯片发布了新的文献求助10
6秒前
8秒前
美好鞅发布了新的文献求助10
9秒前
Moon完成签到,获得积分10
9秒前
GAS发布了新的文献求助10
9秒前
丘比特应助top采纳,获得10
9秒前
困芃完成签到,获得积分10
9秒前
Akim应助阳光的映梦采纳,获得10
10秒前
轩风完成签到,获得积分10
10秒前
CodeCraft应助哈哈哈卷采纳,获得10
10秒前
11秒前
yi发布了新的文献求助10
11秒前
英俊的铭应助wz采纳,获得10
12秒前
12秒前
12秒前
ED应助帅气的猫采纳,获得10
12秒前
Hello应助109902RQ采纳,获得10
12秒前
隐形曼青应助hf采纳,获得10
12秒前
俭朴映阳完成签到,获得积分10
13秒前
ltt发布了新的文献求助10
13秒前
13秒前
高分求助中
Ophthalmic Equipment Market by Devices(surgical: vitreorentinal,IOLs,OVDs,contact lens,RGP lens,backflush,diagnostic&monitoring:OCT,actorefractor,keratometer,tonometer,ophthalmoscpe,OVD), End User,Buying Criteria-Global Forecast to2029 2000
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Cognitive Neuroscience: The Biology of the Mind (Sixth Edition) 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 588
Christian Women in Chinese Society: The Anglican Story 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3961496
求助须知:如何正确求助?哪些是违规求助? 3507837
关于积分的说明 11138394
捐赠科研通 3240311
什么是DOI,文献DOI怎么找? 1790903
邀请新用户注册赠送积分活动 872636
科研通“疑难数据库(出版商)”最低求助积分说明 803288