Beneficial effects of dapagliflozin on cardiac structure in CKD

ACC.25 – In DECODE-CKD among patients with CKD, dapagliflozin reduced LV mass index at 6 months compared with placebo.

This summary is based on the presentation of Tor Biering-Sørensen, MD, PhD (Copenhagen, Denmark]) at the ACC.25 Scientific Session - Effects Of Dapagliflozin On Echocardiographic Measures Of Cardiac Structure And Function In Patients With Chronic Kidney Disease: The DECODE-CKD Trial.

Introduction and methods

Adverse cardiac remodeling is prevalent in patients with CKD and is associated with an increased risk of cardiovascular outcomes. Previous studies have shown that SGLT2 inhibitors reduce cardiovascular outcomes in patients with CKD. The effects of SGLT2 inhibitors on cardiac structure and function are not fully understood.

The DECODE-CKD (Dapagliflozin on EChOcardiographic Measures of CarDiac StructurE and Function in Patients with Chronic Kidney Disease) trial was an investigator-initiated, prospective, single-center, randomized, placebo-controlled trial that evaluated the effects of 10 mg dapagliflozin once daily (n=110) versus matching placebo (n=112) on cardiac structure and function in 222 patients with CKD over a period of 6 months. Echocardiography and blood samples were assesed at baseline and at 6 months.

The primary endpoint was the between-group difference in change in left ventricular (LV) mass index, as determined with echocardiography, at 6 months.

Main results

• Over the 6-month period, the LV mass index significantly decreased in the dapagliflozin group, whereas there was an increase in the placebo group (between-group difference: -8.44 g/m²; 95%CI: -11.83 to -5.06; P<0.001).
• The treatment effect of dapagliflozin on the LV mass index was consistent across all subgroups and was not modified by sex, age, LVEF, NT-proBNP, eGFR, UCAR, GLS (all P for interaction>0.05).
• There were no significant differences between the two groups for the change in LVEF, GLS, LA volume index, LV volumes, NT-proBNP or Troponin I at 6 months (all P>0.05).

Conclusion

In the DECODE-CKD trial among patients with CKD, dapagliflozin reduced LV mass index at 6 months compared with placebo. The effect on LV mass index was consistent across clinically important subgroups. “These findings add important mechanistic insight to the cardioprotective effects of SGLT2 inhibitors in people with CKD,” concluded Tor Biering-Sørensen.

- Our reporting is based on the information provided at the ACC.25 Scientific Session -