Dapagliflozin and Anemia in Patients with Chronic Kidney Disease

作者：Akihiko Koshino, Meir Schechter, Glenn M. Chertow, Priya Vart, Niels Jongs, Robert D. Toto, Peter Rossing, Ricardo Correa‐Rotter, John J.V. McMurray, José Luis Górriz, Rey Isidto, Naoki Kashihara, Anna Maria Langkilde, David C. Wheeler, Hiddo J.L. Heerspink · 发表于：NEJM Evidence · 年份：2023 · 被引用次数：72 · 研究领域：Diabetes Treatment and Management、Erythropoietin and Anemia Treatment、Neurological and metabolic disorders

BACKGROUND: In the DAPA-CKD (Dapagliflozin in Patients with Chronic Kidney Disease) trial, dapagliflozin improved kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) with or without type 2 diabetes (T2D). In this post hoc analysis of DAPA-CKD, we assessed the effects of dapagliflozin on the correction and prevention of anemia. METHODS: The DAPA-CKD trial randomized patients (1:1) with an estimated glomerular filtration rate of 25 to 75 ml/min/1.73 m2 and a urinary albumin-to-creatinine ratio of 200 to 5000 mg/g to receive dapagliflozin 10 mg or placebo daily. Hematocrit was measured at baseline, 2 weeks, 2 and 4 months, and every 4 months thereafter. Anemia was defined as hematocrit less than 39% in men and less than 36% in women. Correction and incidence of anemia were defined as two consecutive measurements above or below these thresholds relative to baseline, respectively, during follow-up. We classified anemia-related adverse events using data from site investigator reports. RESULTS: Mean age of the 4304 participants was 61.8 years, and 67.5% had T2D. Among the 4292 (99.7%) participants with baseline hematocrit data, 1716 (40.0%) had anemia. Over the 2.4-year median follow-up, patients assigned to dapagliflozin had an increase in hematocrit of 2.3 percentage points (95% confidence interval [CI], 2.1 to 2.5) greater than those assigned to placebo. Among patients with anemia at baseline, anemia was corrected in 443 (53.3%) patients randomized to...