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慢性腎疾患の患者,心血管疾患の患者および無患者の臨床結果に対するダパグリフロジンの影響
John J V McMurray1, David C Wheeler2,3, Bergur V Stefánsson4
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (J.J.V.M.).
Circulation
|November 13, 2020
PubMed で要約を見る
まとめ
ダパグリフロジンは慢性腎臓病 (CKD) の患者の腎不全と心血管疾患のリスクを有意に低下させる. 患者の心血管疾患歴に関係なく,この効果は一貫していました.
科学分野:
- 腎臓科
- 心臓病科
- 薬理学について
背景:
- 慢性腎臓病 (CKD) は,末期腎臓病 (ESRD) と心血管疾患の重大なリスクを伴います.
- SGLT2阻害剤であるダパグリフロジンは,CKDの管理において有望であることが示されています.
- 既存の心血管疾患 (CVD) を有する患者および無する患者の有効性を理解することは極めて重要です.
研究 の 目的:
- 慢性腎臓病患者におけるダパグリフロジンの心臓血管および腎臓疾患への影響を評価する.
- 心血管疾患の既往歴のある子集団における薬剤の有効性を評価する.
主な方法:
- DAPA- CKD試験では,4304人のCKD被験者をランダムにダパグリフロジンまたはプラセボに分けました.
- 主要エンドポイント:持続的なeGFR低下,ESRD,または腎臓/心血管疾患による死亡.
- 二次的エンドポイントには,腎臓の複合結果,心不全の入院,心血管疾患による死亡,全原因による死亡が含まれていた.
主要な成果:
- 以前CVD (二次予防) を経験した患者は高齢で,男性である可能性が高く,血圧とBMIが高かった.
- ダパグリフロジンは,プライマリー (HR 0. 61) とセカンダリー (HR 0. 61) 予防群の両方で,プライマリーコンポジットアウトカムに対して同様のリスク低下を示した.
- 心不全の入院/心血管疾患による死亡および全原因の死亡率に関する利点も,サブグループ間で一貫していました.
結論:
- ダパグリフロジンは,腎不全,心血管疾患による死亡,心不全患者の入院リスクを効果的に軽減します.
- ダパグリフロジンの効果は,患者の心血管疾患歴とは無関係です.
- 不良事象の発生率は低く,治療グループ間では比較可能であった.
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