Jongs N, Greene T, Chertow GM, et al. - Treatment with dapagliflozin (SGLT2 inhibitor) significantly decreased albuminuria in chronic kidney disease patients with and without type 2 diabetes, however, a larger relative reduction was observed in patients with type 2 diabetes. Dapagliflozin exerted similar impacts on clinical results in cases with or without type 2 diabetes, but had different impacts on urinary albumin-to-creatinine ratio (UACR); this implies that pathways unrelated to reduction in albuminuria might mediate part of the dapagliflozin-induced protective effect.

• In the multicenter, double-blind, placebo-controlled, randomized trial (DAPA-CKD trial), 4,304 patients with chronic kidney disease were randomized to either dapagliflozin (n=2,152) or placebo (n=2,152).

• Geometric mean UACR was decreased by 29·3% with dapagliflozin vs placebo, and dapagliflozin caused a geometric mean percentage change of −35·1% and −14·8% in patients with and without type 2 diabetes, respectively.

• Dapagliflozin elevated the probability of regression in UACR stage (hazard ratio 1·81) in those (n=3,860) with UACR of 300 mg/g or greater at baseline.

• In cases (n=3,820) with UACR less than 3,000 mg/g at baseline, risk of progression in UACR stage was reduced by dapagliflozin (0·41).

• During dapagliflozin therapy, larger decreases in UACR at day 14 were significantly related to attenuated estimated glomerular filtration rate decline during subsequent follow-up.