For patients with chronic kidney disease (CKD)—with or without type 2 diabetes—treatment with the sodium-glucose co-transporter-2 (SGLT2) dapagliflozin reduces the hospitalization rate overall and for certain categories of disease, according to a study in the Annals of Internal Medicine.
The analysis included data on 4304 patients from the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial. All patients had an estimated glomerular filtration rate of 25–75 mL/min/1.73 m2 and a urinary albumin-creatinine ratio of 200–5000 mg/g. Approximately two-thirds of patients had type 2 diabetes. Patients were randomly assigned to receive dapagliflozin (10 mg once daily) or placebo. Rates of first and subsequent hospitalizations were assessed, along with cause-specific admission risks.
Over a median follow-up of 2.4 years, 28.4% of patients were hospitalized one or more times for any cause. On intention-to-treat analysis, patients assigned to dapagliflozin were at lower risk of initial hospitalization (hazard ratio [HR], 0.84) and of any hospitalization or death (HR, 0.79).
Dapagliflozin-associated reductions in hospitalization rate were unrelated to the presence of type 2 diabetes at baseline. The dapagliflozin group also had lower rates of hospitalization for cardiac disorders, renal and urinary disorders, metabolic and nutritional diseases, and neoplasms. Other causes showed no significant differences, including infections, nervous system disorders, and gastrointestinal disorders. Patients on dapagliflozin also had an increased number of days alive and out of the hospital.
Patients with CKD are at high risk for hospitalizations, associated with increased costs and decreased quality of life. While previous studies have explored the effects of SGLT2 inhibitor therapy on kidney and cardiovascular outcomes, this post hoc analysis adds new evidence on all-cause hospital admissions.
Dapagliflozin reduces hospitalization risk in patients with CKD, with or without type 2 diabetes, the new results suggest. The researchers conclude, “These findings highlight additional benefits of dapagliflozin…[that] should be considered when evaluating the totality of evidence favoring provision of dapagliflozin to patients with CKD” [Schechter M, et al. Effects of dapagliflozin on hospitalizations in patients with chronic kidney disease: A post hoc analysis of DAPA-CKD. Ann Intern Med 2023; 176:59–66. doi: 10.7326/M22-2115].
