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Using Dapagliflozin for Reduction in Adverse Renal and CV Outcomes

Sep 18, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Grace Behr, PharmD/MBA Candidate, Creighton University

Study assessing renal and CV impact found patients had significant reduction in urinary albumin-to-creatinine ratio (UACR) in the first six months of using dapagliflozin.

Dapagliflozin is an SGLT2 inhibitor that has been known to provide benefits to patients with diabetes other than a reduction in A1c. Diabetic kidney disease is a serious concern among patients who have diabetes, as it can lead to complete renal failure. Therefore, a study was conducted by Mosenzon et al. that studied the effects of dapagliflozin on albuminuria. The design of the study took over 17,000 patients and randomized them to the treatment or placebo group. All patients had T2DM, CrCl >60 mL/min, and either atherosclerotic cardiovascular disease (CVD) or risk factors for CVD.

 

For each patient urinary albumin-to-creatinine ratio (UACR) was tested at baseline, 6-months, 12-months, and annually after the first year. The treatment group was given once daily dapagliflozin 10 mg. Each patient was then placed into sub-groups by their baseline eGFR and UACR. According to Mosenzon, “Of the 17,160 [participants], 16,843 (98.15%) had baseline UACR data. There were 9,067 (53.83%) participants with baseline UACR ≤15 mg/g category, of which 551 (3.30%) had albumin below detectable levels; 2,577 (15.30%) with UACR of >15 to <30 mg/g; 4,030 (23.93%) with baseline UACR ≥30 to ≤300 mg/g; and 1,169 (6.94%) with baseline UACR >300 mg/g”. Participants in the lower UACR categories tended to be white females with lower A1cs. Conversely, in the higher baseline, UACR categories, participants were more likely to have elevated A1cs, lower eGFR, and higher systolic blood pressure.

Participant data were collected for four consecutive years and analyzed. The outcome of this study shows the most significant reduction in UACR in the first six months of using dapagliflozin. After that, the UACR stabilized but was still lower than the corresponding placebo group. Across all treatment groups, there was a significant reduction in UACR, leading to a reduction in diabetic kidney disease. In addition, all patients were found to have a reduced chance of deterioration if treated with dapagliflozin.

Practice Pearls:

  • Dapagliflozin has been shown to reduce albuminuria, thus reducing the risk of kidney deterioration in patients with diabetes.
  • Risk reduction with dapagliflozin is effective in all patients regardless of eGFR and UACR.
  • Dapagliflozin is a great treatment choice for patients with diabetes due to the other benefits and risk reduction it provides.

 

Reference for “Using Dapagliflozin for Reduction in Adverse Renal and CV Outcomes”:
Mosenzon, Ofri, et al. “The Effect OF Dapagliflozin on Albuminuria IN Declare-Timi 58.” Diabetes Care, vol. 44, no.
 8, 2021,

 

 

Author: Grace Behr, PharmD/MBA Candidate, Creighton University