Glomerular and tubular effects of dapagliflozin, eplerenone and their combination in patients with chronic kidney disease: A post‐hoc analysis of the ROTATE ‐3 study
Authors' conclusion
Dapagliflozin and eplerenone exert different effects on markers of glomerular and tubular function supporting the hypothesis that different mechanistic pathways may account for their kidney protective effects.
Study context
- Population
- Adults with CKD and urinary albumin excretion ≥100 mg/24 hcross-over
- Participants
- 46 adults
- Comparison
- Dapagliflozin vs eplerenone vs dapagliflozin-eplerenone
Methodological detailsrandomized cross-over, mixed repeated measures models
- Randomized cross-over
- Mixed repeated measures models
Primary result
As reported in the abstract
Heparan sulphate, mean % change from baseline · 4 weeks
Dapagliflozin
−34.8%
mean · 95% CI −52.2–-10.9
Eplerenone
−5.9%
mean · 95% CI −32.5–31.3
Dapagliflozin-eplerenone
−28.1%
mean · 95% CI −48.4–0.1
Further findings
| Outcome | Dapagliflozin | Eplerenone | Dapagliflozin-eplerenone |
|---|---|---|---|
| Plasma aldosterone, mean % change from baseline · 4 weeks | −12.5% (95% CI −35.0–17.8) | 38.9% (95% CI 2.8–87.7) | 32.2% (95% CI −1.5–77.4) |
| Copeptin, mean % change from baseline · 4 weeks | 28.4% (95% CI 10.7–49.0) | 4.2% (95% CI −10.6–21.4) | 23.8% (95% CI 6.6–43.9) |
| Proximal absolute sodium reabsorption rate, change · 4 weeks | 455.9 (95% CI −879.2–-32.6) mmol/min | — not stated in the abstract | −971.0 (95% CI −1411.0–-531.0) mmol/min |
| Distal absolute sodium reabsorption rate, change · 4 weeks | — not stated in the abstract | 523.1 (95% CI −926.1–-120.0) mmol/min | −9.2 (95% CI −402.0–383.6) mmol/min |
— not stated in the abstract
- Proximal absolute sodium reabsorption rate, change: dapagliflozin: decrease of 455.9 as printed
- Distal absolute sodium reabsorption rate, change: eplerenone: decrease of 523.1 as printed
Plasma aldosterone, mean % change from baseline · 4 weeks
- Larger change with eplerenone and dapagliflozin-eplerenone vs dapagliflozin
Distal absolute sodium reabsorption rate, change · 4 weeks
- Dapagliflozin-eplerenone did not affect distal absolute sodium reabsorption
Original publication
Glomerular and tubular effects of dapagliflozin, eplerenone and their combination in patients with chronic kidney disease: A post‐hoc analysis of the ROTATE ‐3 study. Diabetes Obes Metab. Published 5 November 2023. doi:10.
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