Effect of dapagliflozin on urinary albumin excretion in patients with chronic kidney disease with and without type 2 diabetes: new insights from the DAPA-CKD trial Trial

Background: Reductions in albuminuria are associated with a subsequent lower risk of kidney failure in patients with chronic kidney disease (CKD). The sodium-glucose co-transporter 2 inhibitor dapagliflozin significantly reduced albuminuria in patients with type 2 diabetes and normal/near-normal kidney function. Whether this effect persists in patients with CKD with and without diabetes is unknown. We assessed the effects of dapagliflozin on albuminuria in patients with CKD with and without type 2 diabetes from the DAPA-CKD trial (NCT03036150). Methods: We randomised 4304 patients with estimated glomerular filtration rate 25-75 mL/min/1·73m 2 and urinary albumin-to-creatinine ratio (UACR) 200-5000 mg/g to dapagliflozin (10 mg) or placebo. Change in albuminuria was a pre-specified exploratory outcome. Regression in UACR stage, defined as a transition from macroalbuminuria (≥300 mg/g) to micro- or normoalbuminuria (<300 mg/g), and progression in UACR stage, defined as a transition from <3000 mg/g to ≥3000 mg/g, were additional discrete endpoints. Findings