Abstract: TH-PO992
Dapagliflozin and Kidney Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: Results From DELIVER
Session Information
- Late-Breaking Clinical Trials (Posters)
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Claggett, Brian, Brigham and Women's Hospital, Boston, Massachusetts, United States
- de Boer, Rudolf A., Universitair Medisch Centrum Groningen Afdeling Cardiologie, Groningen, Groningen, Netherlands
- Docherty, Kieran F., University of Glasgow, Glasgow, Glasgow, United Kingdom
- Fang, James Chen-Tson, University of Utah Hospital Department of Cardiology, Salt Lake City, Utah, United States
- Hernandez, Adrian Felipe, Duke University School of Medicine, Durham, North Carolina, United States
- Inzucchi, Silvio E., Yale University, New Haven, Connecticut, United States
- Kosiborod, Mikhail, Saint Luke's Health System, Kansas City, Missouri, United States
- Lam, Carolyn, National University of Singapore, Singapore, Singapore
- Martinez, Felipe, Universidad Nacional de Cordoba, Cordoba, Córdoba, Argentina
- Kerr Saraiva, Jose Francisco, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil
- McGrath, Martina M., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Shah, Sanjiv, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Vaduganathan, Muthiah, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Verma, Subodh, Saint Michael's Hospital, Toronto, Ontario, Canada
- Petersson, Magnus, AstraZeneca PLC, Cambridge, Cambridgeshire, United Kingdom
- Langkilde, Anna Maria, AstraZeneca PLC, Cambridge, Cambridgeshire, United Kingdom
- McMurray, John, University of Glasgow, Glasgow, Glasgow, United Kingdom
- Solomon, Scott D., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
SGLT2i reduce heart failure (HF) events and slow progression of kidney disease among patients with HF and reduced ejection fraction (EF). In patients with HF and mildly reduced or preserved EF in DELIVER, dapagliflozin significantly reduced the primary composite outcome of cardiovascular (CV) death or worsening HF. We assessed the influence of baseline kidney function on CV outcomes and the effect of dapagliflozin on renal outcomes and eGFR trajectory.
Methods
DELIVER randomized 6,263 patients with EF>40% and eGFR ≥25 ml/min/1.73m2 to dapagliflozin 10mg per day or placebo. We assessed if baseline kidney function modified the treatment effect on the primary CV outcome and its components. In prespecified exploratory analyses, we examined the treatment effect on eGFR slope and a composite kidney outcome (≥50% decline in eGFR; eGFR <15 ml/min/1.73m2; renal death).
Results
Mean eGFR was 61±19 ml/min/1.73m2; 3,070 (49%) had eGFR <60 ml/min/1.73m2. The effect of dapagliflozin on the primary CV outcome was not influenced by baseline eGFR (hazard [HR] 0.84; 95%CI 0.70,1.00 for eGFR≥60 and HR 0.81; 95%CI 0.69,0.94 for eGFR<60; P-interaction=0.76). Dapagliflozin did not reduce the kidney composite outcome, which occurred in 77 of 3,131 patients assigned to dapagliflozin (2.5%) and 71 of 3,131 assigned to placebo (HR 1.09; 95%CI 0.79,1.50). However, dapagliflozin attenuated the decline in eGFR from month 1 to 36, vs. placebo (difference 1.4 (95%CI 1.0,1.8) ml/min/1.73m2/year) Figure 1.
Conclusion
Baseline kidney function did not modify the benefit of dapagliflozin in patients with HF with mildly reduced or preserved EF. Dapagliflozin slowed the rate of decline in eGFR to a greater extent than placebo.
Funding
- Commercial Support –