Rationale and protocol of the Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • H. J.L. Heerspink
  • B. Stefansson
  • G. Chertow
  • R. Correa-Rotter
  • Tom Greene
  • Fan Fan Hou
  • Magnus Lindberg
  • John McMurray
  • Rossing, Peter
  • Roberto Toto
  • Anna Maria Langkilde
  • David C. Wheeler
  • H. J.L. Heerspink
  • D. C. Wheeler
  • G. Chertow
  • R. Correa-Rotter
  • T. Greene
  • F. F. Hou
  • J. McMurray
  • Rossing, Peter
  • R. Toto
  • B. Stefansson
  • A. M. Langkilde
  • Marc A. Pfeffer
  • Stuart Pocock
  • Karl Swedberg
  • Jean L. Rouleau
  • Nishi Chaturvedi
  • Peter Ivanovich
  • Andrew S. Levey
  • Heidi Christ-Schmidt
  • Johannes Mann
  • Claes Held
  • Christoph Varenhorst
  • Pernilla Holmgren
  • Theresa Hallberg
  • Walter Douthat
  • Roberto Pecoits Filho
  • David Cherney
  • Fan Fan Hou
  • Frederik Persson
  • Hermann Haller
  • István Wittmann
  • Dinesh Khullar
  • Kashihara Naoki
  • Richardo Correa-Rotter
  • Elizabeth Escudero
  • Rey Isidto
  • Michal Nowicki
  • Mikhail Batiushin
  • DAPA-CKD Investigators

Background. Recent cardiovascular outcome trials have shown that sodium-glucose co-transporter 2 (SGLT2) inhibitors slow the progression of chronic kidney disease (CKD) in patients with type 2 diabetes at high cardiovascular risk. Whether these benefits extend to CKD patients without type 2 diabetes or cardiovascular disease is unknown. The Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial (NCT03036150) will assess the effect of the SGLT2 inhibitor dapagliflozin on renal and cardiovascular events in a broad range of patients with CKD with and without diabetes. Methods. DAPA-CKD is a randomized, double-blind, placebo-controlled, trial in which -4300 patients with CKD Stages 2-4 and elevated urinary albumin excretion will be enrolled. The vast majority will be receiving a maximum tolerated dose of a renin-angiotensin system inhibitor at enrolment. Results. After a screening assessment, eligible patients with a urinary albumin:creatinine ratio =200 mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75 mL/min/ 1.73 m2 are randomly assigned to placebo or dapagliflozin 10 mg/day. Enrolment is monitored to ensure that at least 30% of patients do not have diabetes and that no more than 10% have an eGFR >60 mL/min/1.73 m2. The primary endpoint is a composite of a sustained decline in eGFR of =50%, end-stage renal disease, renal death or cardiovascular death. The trial will conclude when 681 primary renal events have occurred, providing 90% power to detect a 22% relative risk reduction (a level of 0.05). Conclusion. DAPA-CKD will determine whether the SGLT2 inhibitor dapagliflozin, added to guideline-recommended therapies, safely reduces the rate of renal and cardiovascular events in patients across multiple CKD stages with and without diabetes.

OriginalsprogEngelsk
TidsskriftNephrology Dialysis Transplantation
Vol/bind35
Udgave nummer2
Sider (fra-til)274-282
ISSN0931-0509
DOI
StatusUdgivet - feb. 2020

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