Clinical Outcomes and Healthcare Resource Utilization in a Real-World Population Reflecting the DAPA-CKD Trial Participants

INTRODUCTION: The DAPA-CKD trial assessed dapagliflozin in patients with chronic kidney disease (CKD) with or without type 2 diabetes (T2D). To aid interpretation of results, renal and cardiovascular outcomes plus healthcare resource utilization (HCRU) and costs were assessed in a real-world population similar to that of DAPA-CKD. METHODS: at index and urine albumin-to-creatinine ratio (UACR) 0-5000 mg/g; n = 22, 251]. Included patients had confirmatory eGFR ≥ 90 days post-index and no kidney transplant or progression to end-stage kidney disease during 12 months pre-index. The final population (n = 6557) was stratified by UACR (0-29, 30-199 and 200-5000 mg/g; the last comprising the DAPA-CKD-like cohort). Patients were followed for 5 years post-index. RESULTS: Adverse clinical outcomes incidence increased with UACR and was highest for the DAPA-CKD-like cohort (UACR 200-5000 mg/g) versus lower UACR categories (0-29 mg/g and 30-199 mg/g): renal composite outcome (progression to CKD stage 5, dialysis, transplant, ≥ 50% sustained eGFR decline): 26. 0% versus 2. 2% and 5. 8%; heart failure (HF): 36. 1% versus 13. 9% and 24. 6%; myocardial infarction: 11. 3% versus 4. 7% and 7. 4%; stroke: 8. 9% versus 4. 0% and 5. 7%; and mortality: 18. 5% versus 6. 0% and 11. 7%, respectively. Within the DAPA-CKD-like cohort, patients with versus without T2D or HF had a higher frequency of adverse outcomes. The DAPA-CKD-like cohort also had significantly higher annualized per-patient healthcare costs (39, 222/year versus 19, 547/year), hospital admission rate (0. 55/year versus 0. 20/year) and outpatient specialist visit rate (7. 55/year versus 6. 74/year) versus the lowest UACR category. CONCLUSION: The significant adverse renal and cardiovascular outcomes observed, particularly in the DAPA-CKD-like cohort, represent a substantial burden resulting in increased mortality, HCRU and costs, demonstrating the need for additional treatment options.