Hypoglycemic "new star" new discovery? Dapagliflozin reduces the risk of hospitalization in patients with CKD, with or without T2DM

Recently, the latest post-hoc analysis of the DAPA-CKD trial was published
in the journal Annals of Internal Medicine.
Studies have shown that the use of the SGLT2 inhibitor dapagliflozin in patients with or without type 2 diabetes can reduce the risk of
all-cause hospitalization.

New exploration of SGLT2i inhibitors

Data from a previous randomized, double-blind, placebo-controlled phase 3 DAPA-CKD trial have shown that dapagliflozin has an "overwhelming benefit" over placebo in patients with CKD: treatment reduces renal deterioration or kidney death events
compared to placebo, regardless of the patient's diabetes status.

Although the cardiovascular and renal effects of SGLT2 inhibitors have been extensively studied, there are few
data evaluating the effects of SGLT2 inhibitors on hospitalization for any cause.

In this study, Schechter and colleagues examined data from 4,304 patients with CKD (mean age 61.
8 years; 33.
1% women) to investigate the effect
of dapagliflozin (10 mg, qd) compared to placebo on the first and subsequent hospitalization events.
A total of 2,906 patients with type 2 diabetes CKD were included, of whom 1,455 received dapagliflozin and 1,451 received placebo; A total of 1398 patients with non-type 2 diabetes CKD were included, of whom 697 received dapagliflozin and 701 received placebo
.

21%！ Dapagliflozin reduces the risk of all-cause hospitalization

During a median follow-up of 2.
4 years, 1224 (28.
4%) participants reported 2072 inpatient events
.
Compared to placebo:

➤ The risk of first hospital admission (HR 0.
84, 95% CI 0.
75 to 0.
94) and all-cause hospitalisation or death events (RR 0.
79, 95% CI 0.
70 to 0.
89) were significantly lower
in the dapagliflozin group.

➤ 26.
3% of patients in the dapagliflozin group had at least one hospitalization event, with an event rate of 143.
7 cases per 1000 person-years; In the placebo group, the proportion was 30.
6%, and the event rate was 171.
9 cases per 1000 person-years
.

➤ Further analysis found that compared with placebo, the risk of hospitalization for heart disease (RR = 0.
67, 95% CI 0.
53 to 0.
86), kidney and urinary disease (RR = 0.
061, 95% CI 0.
46 to 0.
79), metabolic and nutritional disorders (RR = 0.
61, 95% CI 0.
41 to 0.
91), and tumor (RR = 0.
62, 95% CI 0.
39 to 0.
96) was significantly lower
in the dapagliflozin group.

➤ Dapagliflozin confered similar first- and all-cause hospital benefits regardless of baseline concomitant type 2 diabetes (interaction P = 0.
60)

Summary of this article

"These findings highlight benefits other than dapagliflozin hypoglycemic lowering – reducing the risk of hospitalization in patients with CKD, regardless of type 2 diabetes, and these benefits
should be taken into account when developing clinical management strategies for patients with CKD," the researchers said.
”

Compiled from: Schechter M, et al.
Ann Intern Med.
2022; doi:10.
7326/M22-2115.

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