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Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin‐angiotensin blockers
Author(s) -
Heerspink H. J. L.,
Johnsson E.,
GauseNilsson I.,
Cain V. A.,
Sjöström C. D.
Publication year - 2016
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12654
Subject(s) - dapagliflozin , albuminuria , medicine , urology , placebo , microalbuminuria , endocrinology , diabetes mellitus , renal function , type 2 diabetes , blood pressure , alternative medicine , pathology
Aims To characterize the effect of dapagliflozin on albuminuria and estimated glomerular filtration rate ( eGFR ) and to determine whether effects on albuminuria were mediated through changes in glycated haemoblogin ( HbA1c ), systolic blood pressure ( SBP ), body weight or eGFR . Methods We conducted a post hoc analysis of data pooled from two phase III clinical trials in hypertensive patients with type 2 diabetes ( T2DM ) on stable angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker therapy, randomly assigned to dapagliflozin 10 mg/day or matched placebo. This analysis included only patients with microalbuminuria or macroalbuminuria at baseline. Results Patients were randomized to receive dapagliflozin 10 mg (n = 167) or placebo (n = 189). Dapagliflozin resulted in greater 12‐week reductions in albuminuria compared with placebo: −33.2% [95% confidence interval ( CI ) −45.4, −18.2]. The reduction in albuminuria was also present after adjusting for age, sex and changes in HbA1c , SBP , body weight and eGFR : −23.5% (95% CI −37.6, −6.3). There was a decrease in eGFR with dapagliflozin versus placebo that was readily reversed 1 week after last dose. No serious renal‐related adverse events were observed in any group. Conclusions Dapagliflozin was effective in lowering albuminuria in patients with T2DM and hypertension using renin‐angiotensin system blockade therapy. Reductions in albuminuria were still present after adjusting for changes in HbA1c , SBP , body weight and eGFR . Dapagliflozin‐induced improvements in glycaemic control and reductions in SBP , coupled with other potentially beneficial renal effects, may lead to a reduced long‐term renal and cardiovascular risk.