Baseline, Early Changes, and Residual Albuminuria

作者：Dominique van Mil, Priya Vart, Glenn M. Chertow, Ron T. Gansevoort, Peter Rossing, Robert D. Toto, R Correa-Rotter, Anna Maria Langkilde, C. David Sjöström, David C. Wheeler, Hiddo J.L. Heerspink · 发表于：Clinical Journal of the American Society of Nephrology · 年份：2024 · DOI：10.2215/cjn.0000000000000550 · 被引用次数：12 · 研究领域：Diabetes Treatment and Management、Diabetes Management and Research、Pancreatic function and diabetes

Key Points Dapagliflozin reduced albuminuria in participants with CKD, with reductions being proportional to reductions in the risk of disease progression. Residual albuminuria (at month 4) was linked to higher risks of primary and kidney end points, with no heterogeneity by diabetes status or allocated treatment. Participants with residual albuminuria at month 4 had high rates of kidney end points, implying the need for added therapy for long-term kidney and cardiovascular benefits. Background Albuminuria is a strong indicator of kidney and cardiovascular risk in patients with CKD. We assessed risk associations between albuminuria at baseline and 4 months after randomization in a placebo-controlled trial of dapagliflozin and kidney end points in patients with CKD and albuminuria, with and without type 2 diabetes. Methods In this post hoc analysis of the dapagliflozin and prevention of adverse outcomes in CKD (DAPA-CKD) trial, 4304 adult patients with CKD were randomized to dapagliflozin 10 mg or placebo as an adjunct to maximally tolerated renin-angiotensin system inhibitors. The primary end point was a composite of sustained ≥50% decline in eGFR, kidney failure, or death from kidney or cardiovascular cause. The kidney composite end point was similar, but excluded cardiovascular death. We assessed associations among baseline albuminuria, early change in albuminuria (baseline to month 4), and residual albuminuria (month 4) with the primary composite and kidney composite end p...