Kidney Week

Abstract: FR-OR26

Dapagliflozin Effect on Hospital Admissions in Patients With CKD: A Post Hoc Analysis of the DAPA-CKD Trial

Session Information

• CKD: Clinical Outcomes, Trials, Mechanistic Insights
  November 04, 2022 | Location: W307, Orange County Convention Center‚ West Building
  Abstract Time: 05:15 PM - 05:24 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

• Schechter, Meir, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands

Meir Schechter, MD, PhD

• Jongs, Niels, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands

Niels Jongs,

• Chertow, Glenn, Stanford University School of Medicine, Stanford, California, United States

Glenn Chertow,

• Mosenzon, Ofri, Hadassah University Medical Center, Jerusalem, Jerusalem, Israel

Ofri Mosenzon,

• McMurray, John, University of Glasgow, Glasgow, Glasgow, United Kingdom

John McMurray,

• Correa-Rotter, Ricardo, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico

Ricardo Correa-Rotter,

• Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark

Peter Rossing,

• Langkilde, Anna Maria, AstraZeneca, BioPharmaceuticals R&D, Gothenburg, Sweden

Anna Maria Langkilde,

• Sjostrom, David, AstraZeneca, BioPharmaceuticals R&D, Gothenburg, Sweden

David Sjostrom,

• Toto, Robert D., UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, United States

Robert D. Toto,

• Wheeler, David C., University College London Faculty of Medical Sciences, London, London, United Kingdom

David C. Wheeler,

• L Heerspink, Hiddo Jan, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands

Hiddo Jan L Heerspink,

Background

The DAPA-CKD trial demonstrated that the sodium glucose co-transporter 2 inhibitor dapagliflozin improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) with or without type 2 diabetes (T2D). In a post-hoc analysis, we investigated the effect of dapagliflozin on all-cause hospital admissions (ACHA).

Methods

We randomized 4304 adults with estimated glomerular filtration rate (eGFR) 25–75mL/min/1.73m² and urinary albumin-to-creatinine ratio (UACR) 200–5000mg/g to either dapagliflozin 10mg or placebo once daily (1:1). Treatment effects on first and all (first and recurrent) ACHA were assessed in the whole population and in the prespecified eGFR (<45 or ≥45mL/min/1.73m²) and UACR (≤1000 or >1000mg/g) subgroups. We used the system organ class classification as reported by investigators to evaluate the effects of dapagliflozin on different causes of admission. Admissions were analyzed using Cox-proportional hazards regression models (first ACHA), the Lin-Wei-Ying-Yang method (all ACHA), and negative binomial models (all admissions related to specific causes).

Results

Over a median follow-up of 2.4 years, ACHA occurred in 566 (26.3%) patients in the dapagliflozin group and 658 (30.6%) in the placebo group. Compared to placebo, dapagliflozin reduced the risk of first ACHA (HR 0.84 [95%CI 0.75–0.94]; P<0.001; number needed to treat over the study period of 23 [95%CI 14–63]) and all ACHA (RR 0.79 [95%CI 0.70–0.89]; P=0.002). The effect of treatment was consistent across the eGFR and UACR subgroups (P-interaction ≥0.215). Compared to placebo, dapagliflozin reduced the rate of admissions due to cardiac disorders (438 events; RR 0.67 [95% CI 0.53–0.86]), renal and urinary disorders (313 events; RR 0.61 [95% CI 0.46–0.79]), metabolism and nutrition disorders (134 events; RR 0.61 [95% CI 0.41–0.91]), and neoplasms (84 events; RR 0.62 [95% CI 0.39–0.96]; all P≤0.033).

Conclusion

Dapagliflozin reduced the risk of ACHA among patients with CKD, with or without T2D. These findings may have significant implications for quality of life in individual patients and the overall healthcare burden and expenditure attributed to CKD.

Funding

• Commercial Support – AstraZeneca