Effect of dapagliflozin on kidney and cardiovascular outcomes by baseline KDIGO risk categories: a post hoc analysis of the DAPA-CKD trial – published online 21/04/2022

Simke W. Waijer, Priya Vart, David Z. I. Cherney, Glenn M. Chertow, Niels Jongs, Anna Maria Langkilde, Johannes F. E. Mann, Ofri Mosenzon, John J. V. McMurray, Peter Rossing, Ricardo Correa-Rotter, Bergur V. Stefansson, Robert D. Toto, David C. Wheeler, Hiddo J. L. Heerspink

Higher albuminuria and lower estimated glomerular filtration rate (eGFR) are predictors of kidney failure and cardiovascular events, and are the basis of Kidney Disease Improving Global Outcomes (KDIGO) risk categorisation. It is unknown if dapagliflozin’s clinical benefits are generalisable to different chronic kidney disease (CKD) stages, defined by baseline KDIGO risk. In this issue, Waijer et al (https://doi.org/10.1007/s00125-022-05694-6) report the effect of dapagliflozin versus placebo on kidney and cardiovascular outcomes in patients with CKD categorised by KDIGO risk. Dapagliflozin consistently reduced the risk of kidney and cardiovascular events compared with placebo, across all KDIGO risk categories, in patients with or without type 2 diabetes. The benefit of dapagliflozin in slowing eGFR decline was also similar across KDIGO risk categories, as was dapagliflozin safety. The authors conclude that these findings support use of dapagliflozin in a broad range of patients with CKD who are at risk of progressive kidney and cardiovascular disease, to prevent clinically important outcomes.

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