Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes
Authors' conclusion
Risk models for kidney disease progression can be applied in patients with T2D to stratify risk and identify those who experience a greater magnitude of benefit from SGLT2 inhibition.
Study context
- Population
- Patients with T2D from four Thrombolysis In Myocardial Infarction (TIMI) clinical trials
- Participants
- 41,204 patients4 TIMI trials
- Comparison
- Dapagliflozin efficacy by kidney risk category in DECLARE-TIMI 58
- Outcome
- Kidney disease progression: composite of sustained ≥40% eGFR decline, end-stage kidney disease or kidney death
Methodological detailsderivation (70%) and validation (30%) cohorts, multivariable Cox regression, pooled from four TIMI clinical trials
- Derivation (70%) and validation (30%) cohorts
- Multivariable Cox regression
- Pooled from four TIMI clinical trials
Performance
As reported in the abstract
Discrimination of the risk model (c-index) · median follow-up 2.4 years
Derivation
0.798
c-index · 95% CI 0.774–0.821
Validation
0.798
c-index · 95% CI 0.765–0.831
- Events
- 695
- Calibration plot slope, validation cohort
- 0.98 (95% CI 0.93-1.04)
Further findings
Dapagliflozin efficacy on kidney disease progression by risk category · 4 years
- Greater absolute risk reduction with higher baseline risk; absolute risk reduction in highest risk group (≥1%/year)
- 3.5%
- Relative risk reductions with dapagliflozin did not differ across risk categories
2022 Chronic Kidney Disease Prognosis Consortium risk model
- Results were similar
Original publication
Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes. Diabetes Care. Published 9 August 2023. doi:10.
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