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The effects of dapagliflozin on cardio-renal risk factors in patients with type 2 diabetes with or without renin-angiotensin system inhibitor treatment: a post hoc analysis
Diabetes Centre, Department of Internal Medicine, Amsterdam University Medical Centres, location VUmc, Amsterdam, Netherlands.
Diabetes Centre, Department of Internal Medicine, Amsterdam University Medical Centres, location VUmc, Amsterdam, Netherlands.
Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico.
University of Texas Southwestern Medical Center, Dallas, TX, United States.
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2019 (English)In: Diabetes, obesity and metabolism, ISSN 1462-8902, E-ISSN 1463-1326Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: Renin-angiotensin system inhibitors (RASi) are the most effective treatments for diabetic kidney disease but significant residual renal risk remains, possibly because of other mechanisms of kidney disease progression unrelated to RAS that may be present. Sodium-glucose co-transporter-2 inhibitors reduce albuminuria and may complement RASi by offering additional renal protection. This post hoc analysis investigated the effects of dapagliflozin on cardio-renal risk factors in patients with type 2 diabetes (T2D) with increased albuminuria treated with or without RASi at baseline. Materials and methods: We evaluated the effects of dapagliflozin 10 mg/day over 12–24 weeks across 13 placebo-controlled studies in patients with T2D with a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g at baseline. Patients were divided into two subgroups based on treatment with or without RASi at baseline. Results: Compared with patients with RASi at baseline (n = 957), patients without RASi (n = 302) were younger, had a shorter duration of diabetes (7 vs. 12 years), higher estimated glomerular filtration rate (eGFR) and lower UACR, serum uric acid (sUA), body weight and systolic blood pressure. Placebo-adjusted treatment effects of dapagliflozin on UACR, eGFR, glycated haemoglobin and haematocrit over 24 weeks were similar across groups. Mean reductions in body weight and sUA were more distinct in patients without RASi treatment at baseline. Conclusions: Treatment with dapagliflozin over 24 weeks provides similar clinically relevant improvements in metabolic and haemodynamic parameters, and similar reductions in UACR, in patients with T2D with elevated albuminuria treated with or without RASi at baseline. © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019.
Keywords [en]
cardiac and renal risk factors, dapagliflozin, RASi, SGLT-2 inhibitors, type 2 diabetes
National Category
Endocrinology and Diabetes Cardiac and Cardiovascular Systems
Research subject
Bioinformatics
Identifiers
URN: urn:nbn:se:his:diva-18057DOI: 10.1111/dom.13923PubMedID: 31742881Scopus ID: 2-s2.0-85076732648OAI: oai:DiVA.org:his-18057DiVA, id: diva2:1382336
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-01-09Bibliographically approved

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