Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Diabetes Care. 2022 Oct 1;45(10):2350-2359. doi: 10.2337/dc22-0382.
OBJECTIVE: In patients with moderate to severe albuminuric kidney disease, sodium-glucose cotransporter 2 inhibitors reduce the risk of kidney disease progression. These post hoc analyses assess the effects of dapagliflozin on kidney function decline in patients with type 2 diabetes (T2D), focusing on populations with low kidney risk. RESEARCH DESIGN AND METHODS: In the Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58 (DECLARE-TIMI 58) trial, patients with T2D at high cardiovascular risk were randomly assigned to dapagliflozin versus placebo. Outcomes were analyzed by treatment arms, overall, and by Kidney Disease: Improving Global Outcomes (KDIGO) risk categories. The prespecified kidney-specific composite outcome was a sustained decline ≥40% in the estimated glomerular filtration rate (eGFR) to <60 mL/min/1.73 m2, end-stage kidney disease, and kidney-related death. Other outcomes included incidence of categorical eGFR decline of different thresholds and chronic (6 month to 4 year) or total (baseline to 4 year) eGFR slopes. RESULTS: Most participants were in the low-moderate KDIGO risk categories (n = 15,201 [90.3%]). The hazard for the kidney-specific composite outcome was lower with dapagliflozin across all KDIGO risk categories (P-interaction = 0.97), including those at low risk (hazard ratio [HR] 0.54, 95% CI 0.38-0.77). Risks for categorical eGFR reductions (≥57% [in those with baseline eGFR ≥60 mL/min/1.73 m2], ≥50%, ≥40%, and ≥30%) were lower with dapagliflozin (HRs 0.52, 0.57, 0.55, and 0.70, respectively; P < 0.05). Slopes of eGFR decline favored dapagliflozin across KDIGO risk categories, including the low KDIGO risk (between-arm differences of 0.87 [chronic] and 0.55 [total] mL/min/1.73 m2/year; P < 0.0001). CONCLUSIONS: Dapagliflozin mitigated kidney function decline in patients with T2D at high cardiovascular risk, including those with low KDIGO risk, suggesting a role of dapagliflozin in the early prevention of diabetic kidney disease.
目的:在中重度白蛋白尿肾脏疾病患者中,钠-葡萄糖共转运蛋白 2 抑制剂可降低肾脏疾病进展风险。这些事后分析评估了达格列净对 2 型糖尿病(T2D)患者肾脏功能下降的影响,重点关注低肾脏风险人群。
研究设计和方法:在达格列净对心血管事件的影响-心肌梗死溶栓 58 试验(DECLARE-TIMI 58)中,高心血管风险的 T2D 患者被随机分配至达格列净组或安慰剂组。根据治疗组、整体和肾脏疾病:改善全球结局(KDIGO)风险类别对结局进行分析。预先指定的肾脏特异性复合结局为估算肾小球滤过率(eGFR)持续下降≥40%,降至<60 mL/min/1.73 m2、终末期肾病和肾脏相关死亡。其他结局包括不同阈值的 eGFR 下降发生率和慢性(6 个月至 4 年)或总(基线至 4 年)eGFR 斜率。
结果:大多数参与者处于低中度 KDIGO 风险类别(n=15201 [90.3%])。在所有 KDIGO 风险类别中,达格列净的肾脏特异性复合结局风险较低(P 交互=0.97),包括低风险类别(风险比[HR]0.54,95%CI 0.38-0.77)。达格列净降低了 eGFR 下降的分类风险(≥57%[基线 eGFR≥60 mL/min/1.73 m2]、≥50%、≥40%和≥30%)(HR 分别为 0.52、0.57、0.55 和 0.70;P<0.05)。eGFR 下降斜率有利于达格列净,横跨 KDIGO 风险类别,包括低 KDIGO 风险(慢性时臂间差异为 0.87 [慢性]和 0.55 [总]mL/min/1.73 m2/年;P<0.0001)。
结论:达格列净减轻了高心血管风险的 T2D 患者的肾脏功能下降,包括低 KDIGO 风险患者,提示达格列净在糖尿病肾病的早期预防中具有作用。
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