Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Dapagliflozin reduced the risk of hospitalization in patients with chronic kidney disease (CKD) with and without type 2 diabetes (T2DM).

2. Dapagliflozin also reduced the risk of mortality in patients with CKD.

Evidence Rating Level: 1 (Excellent)

Study Rundown:

Patients with CKD are at high risk for repeated hospitalizations. These hospitalizations are associated with worse long-term prognosis, diminished quality of life, and increased CKD-related burden on the healthcare system. Prior randomized control trials have demonstrated that sodium-glucose co-transporter-2 (SGLT2) inhibitors reduced the risk for adverse cardiovascular outcomes and attenuate the progression of kidney disease in patients with T2DM. However, there is a gap in knowledge as to understanding the effects of SGLT2 inhibitors on all-cause hospitalizations. Overall, this study found that dapagliflozin reduced the risk for first hospitalizations and all (first and subsequent) hospitalizations in patients with CKD with or without T2DM. This study was limited by being a post hoc analysis, and the decision to hospitalize patients was influenced by multiple factors unrelated to disease severity. These include type of provider and their level of experience with patients with CKD. Nevertheless, these study’s findings are significant, as they demonstrate that dapagliflozin reduced the risk of hospitalization among patients with CKD with and without T2DM and increased the number of days alive and out of the hospital.

Relevant Reading: Summary for Patients: Effects of Dapagliflozin on Hospitalizations in Patients With Chronic Kidney Disease

In-Depth [randomized controlled trial]:

This double-blind, multicenter, randomized, placebo-controlled trial studied dapagliflozin in patients with CKD. Patients who were aged 18 years or older, had a baseline eGFR of 25 to 75 mL/min/1.73 m2, and had a urinary albumin–creatinine ratio (UACR) of 22.6 to 565.6 mg/mmol were eligible for the study. Patients who had type 1 diabetes, polycystic kidney disease, lupus nephritis, or antineutrophil cytoplasmic antibody–associated vasculitis and patients receiving immunotherapy for other kidney diseases were excluded from the study. The primary outcomes measured were first hospitalizations for any cause, all hospitalizations, and cause-specific (first and recurrent) hospitalizations. Outcomes in the primary analysis were assessed via Cox proportional hazard regression models and negative binomial models. Based on the primary analysis, during a median follow-up of 2.4 years, 2,072 hospitalizations were reported among 1,224 (28.4%) participants. Compared with placebo, dapagliflozin reduced risk for a first hospitalization (Hazard Ratio, 0.84; 95% Confidence Interval [CI], 0.75 to 0.94) and all hospitalizations or death (Rate Ratio, 0.79; 95% CI, 0.70 to 0.89). There was no evidence that the effects of dapagliflozin on first and all hospitalizations varied by baseline presence of T2DM (p for interaction=0.60 for each). Compared with placebo, dapagliflozin reduced the rate of admissions due to cardiac disorders, renal and urinary disorders, metabolism and nutrition disorders, and neoplasms. Overall, this study demonstrates that dapagliflozin reduced the risk of hospitalization for any cause in patients with CKD with and without T2DM.

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