Kidney Week

Abstract: SA-OR36

Effects of Dapagliflozin on Anemia in Patients With CKD With or Without Type 2 Diabetes: A Pre-Specified Analysis of the DAPA-CKD Trial

Session Information

• High-Impact CKD Potpourri: Something for Everyone
  November 05, 2022 | Location: W307, Orange County Convention Center‚ West Building
  Abstract Time: 05:15 PM - 05:24 PM

Category: Anemia and Iron Metabolism

• 200 Anemia and Iron Metabolism

Authors

• L Heerspink, Hiddo Jan, Universiteit Groningen Faculteit Medische Wetenschappen, Groningen, Groningen, Netherlands

Hiddo Jan L Heerspink, PhD

• Koshino, Akihiko, Universiteit Groningen Faculteit Medische Wetenschappen, Groningen, Groningen, Netherlands

Akihiko Koshino,

• Schechter, Meir, Universiteit Groningen Faculteit Medische Wetenschappen, Groningen, Groningen, Netherlands

Meir Schechter,

• Vart, Priya, Universiteit Groningen Faculteit Medische Wetenschappen, Groningen, Groningen, Netherlands

Priya Vart,

• Jongs, Niels, Universiteit Groningen Faculteit Medische Wetenschappen, Groningen, Groningen, Netherlands

Niels Jongs,

• Chertow, Glenn, Stanford Medicine, Stanford, California, United States

Glenn Chertow,

• Toto, Robert D., UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, United States

Robert D. Toto,

• Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Denmark

Peter Rossing,

• Correa-Rotter, Ricardo, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico, Mexico

Ricardo Correa-Rotter,

• McMurray, John, University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, Glasgow, United Kingdom

John McMurray,

• Langkilde, Anna Maria, AstraZeneca, BioPharmaceuticals R&D, Gothenburg, Västergötland, Sweden

Anna Maria Langkilde,

• Wheeler, David C., University College London Faculty of Medical Sciences, London, London, United Kingdom

David C. Wheeler,

Background

Anemia is a common complication of chronic kidney disease (CKD) and is associated with worse outcomes. The sodium-glucose cotransporter 2 inhibitor dapagliflozin increased erythropoietin and hematocrit (Hct) and corrected anemia in patients with heart failure. We examined the effect of dapagliflozin in preventing and correcting anemia in patients with CKD with or without type 2 diabetes (T2D).

Methods

The DAPA-CKD study randomized patients with eGFR 25-75 mL/min/1.73m² and UACR 200-5000 mg/g to dapagliflozin 10mg or placebo. Hct was measured at baseline, 14 days, 2 and 4 months, and every 4 months thereafter. Anemia was defined as Hct levels <39% in males or <36% in females. Investigators’ reporting was used to define anemia-related adverse events. The effect of dapagliflozin on Hct was assessed using mixed effect model for repeated measures. Treatment effect in preventing and reversing anemia was assessed by Cox proportional hazard regression models.

Results

Of patients with Hct levels at baseline (N=4292 [99.7%]; mean Hct 38.9%), 1549 (36.1%) had anemia. Patients with anemia had lower mean eGFR (40 vs 45mL/min/1.73m²) and higher median UACR (1124 vs 877mg/g) compared to those without anemia. Over 2.4 years’ median follow-up, dapagliflozin increased absolute Hct levels vs placebo by 2.3% (95%CI 2.1-2.5; p<0.001). In patients without anemia at baseline, 134 (9.7%) developed anemia with dapagliflozin vs 228 (17.0%) with placebo (HR 0.53; 95%CI 0.43-0.66; p<0.001). Dapagliflozin reduced the risk of anemia-related adverse events compared to placebo (HR 0.46; 95%CI 0.23-0.95; p=0.04). In patients with anemia at baseline, anemia was corrected in 343 patients (47.5%) receiving dapagliflozin and 192 (24.8%) receiving placebo (HR 2.27; 95%CI 1.90-2.71; p<0.001). The effects of dapagliflozin in preventing and correcting anemia were consistent in patients with and without T2D (p interaction ≥0.83).

Conclusion

The effects of dapagliflozin on Hct may support its role in prevention and treatment of anemia in patients with CKD with or without T2D.

Funding

• Commercial Support – AstraZeneca