DAPA CKD Trial Explained: Dapagliflozin and Kidney Protection

DAPA CKD was one of the landmark trials that helped redefine the role of SGLT2 inhibitors in chronic kidney disease. In this Nephrology Notebook episode, we review the rationale, design, eligibility criteria, primary outcome, secondary endpoints, safety profile, limitations, and practical teaching implications of dapagliflozin in albuminuric CKD. We also use Arthur, a hypothetical teaching case, to show how the trial applies to a representative patient with type 2 diabetes, hypertension, reduced eGFR, and persistent albuminuria despite RAAS blockade. This video is for educational purposes only and is not individualized medical advice. Any patient case discussed is hypothetical and should not be interpreted as treatment guidance for any real patient. Reference: Heerspink HJL et al. Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine. 2020. Key Points 1. DAPA CKD tested dapagliflozin 10 milligrams daily in selected patients with albuminuric CKD. 2. The primary composite outcome was sustained major eGFR decline, end stage kidney disease, or death from kidney or cardiovascular causes. 3. Dapagliflozin reduced the primary composite outcome with a hazard ratio of 0.61. 4. The number needed to treat was 19 over a median of 2.4 years to prevent one primary composite event. 5. Benefits were generally consistent in participants with and without type 2 diabetes. 6. The early eGFR dip is usually hemodynamic, but large or symptomatic declines require reassessment. 7. Trial results apply best to patients who resemble the studied population: albuminuric CKD, eGFR 25 to 75, and UACR 200 to 5000 milligrams per gram.