NICE guidance - dapagliflozin for treating chronic kidney disease

Dapagliflozin for treating chronic kidney disease

NICE suggest that (1):

• Dapagliflozin is recommended as an option for treating chronic kidney disease (CKD) in adults. It is recommended only if:
  • it is an add-on to optimised standard care including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated, and
  • people have an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m2 to 75 ml/min/1.73 m2 at the start of treatment and:
    • have type 2 diabetes or
    • have a urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more

Study evidence supporting use of dapagliflozin for chronic kidney disease comes from the DAPA-CKD trial where (2,3):

• dapagliflozin significantly reduced the risk of kidney failure, CV death or HF hospitalization, and all-cause mortality in patients with CKD, with and without T2DM, compared to placebo

Reference:

• NICE (March 2022).Dapagliflozin for treating chronic kidney disease
• Heerspink HJL et al. Rationale and protocol of the Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial. Nephrol Dial Transplant. 2020 Feb 1;35(2):274-282. doi: 10.1093/ndt/gfz290.
• European Society of Cardiology (August 30th 2020). DAPA-CKD trial meets primary endpoint in patients with chronic kidney disease. DAPA-CKD trial presented in a Hot Line Session today at ESC Congress 2020.