To examine outcomes in patients with chronic kidney disease, or CKD, with and without type 2 diabetes by history of HF at baseline, researchers assessed data on 4,304 patients—including 468 with a diagnosis of HF at baseline—from the DAPA-CKD study who had been randomized to dapagliflozin 10 mg once daily or placebo. The primary composite endpoint was 50% or greater decline in estimated glomerular filtration rate, end-stage kidney disease, or kidney/cardiovascular death. Secondary endpoints were a kidney composite (primary endpoint minus cardiovascular death), the composite of cardiovascular death/HF hospitalization, and all-cause death.
Although HF hospitalization/cardiovascular death and death from any cause rates were higher in patients with HF, the secondary kidney failure outcome occurred at the same rate in those with and without HF. When compared with placebo, dapagliflozin reduced the risk for the primary outcome in both patients with HF (HR, 0.58) and those without HF (HR, 0.62). For the cardiovascular death/HF hospitalization composite (HRs, 0.68 vs 0.70, respectively), as well as for all-cause death (HRs, 0.56 vs 0.73), proportional risk-reductions were similar in patients with and without HF; however, absolute risk reductions were greater for those with HF.
Adverse events were low in patients with and without HF. “Dapagliflozin reduced the risk of kidney failure and cardiovascular death/HF hospitalization and prolonged survival in CKD patients with or without type 2 diabetes, independently of history of HF,” concluded the study authors.
