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Heerspink et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. PMID 32970396

One-paragraph summary

DAPA-CKD randomized 4,304 adults with eGFR 25–75 mL/min/1.73 m² and uACR 200–5,000 mg/g to dapagliflozin 10 mg or placebo on standard care. Over median 2.4 years, the primary composite occurred in 9.2% versus 14.5%.

Key findings

  • Primary composite: HR 0.61 (95% CI 0.51–0.72); NNT 19 (15–27). (Heerspink 2020, PMID 32970396)
  • Kidney-specific composite: HR 0.56 (95% CI 0.45–0.68). (Heerspink 2020, PMID 32970396)
  • CV death or heart-failure hospitalization: HR 0.71 (95% CI 0.55–0.92). (Heerspink 2020, PMID 32970396)
  • All-cause death: 4.7% versus 6.8%; HR 0.69 (95% CI 0.53–0.88). (Heerspink 2020, PMID 32970396)

Limitations

  • Albuminuric entry criterion limits direct event inference in A1 CKD.
  • The trial stopped early for efficacy; median follow-up was 2.4 years.
  • Background care and event definitions constrain cross-trial comparisons.

Why it matters

It established an outcome benefit in CKD irrespective of diabetes and changed the eligibility frame for SGLT2 inhibition.

Cited by wiki pages

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  • diabetic kidney disease