AIMS Renin-angiotensin system inhibitors (RASi) are the most effective treatments for diabetic kidney disease but significant residual renal risk remains, possibly because of other mechanisms of kidney disease progression unrelated to RAS that may be present. Sodium-glucose co-transporter-2 inhibitors reduce albuminuria and may complement RASi by offering additional renal protection. This post hoc analysis investigated the effects of dapagliflozin on cardio-renal risk factors in patients with type 2 diabetes (T2D) with increased albuminuria treated with or without RASi at baseline. MATERIALS AND METHODS We evaluated the effects of dapagliflozin 10 mg/day over 12-24 weeks across 13 placebo-controlled studies in patients with T2D with a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g at baseline. Patients were divided into two subgroups based on treatment with or without RASi at baseline. RESULTS Compared with patients with RASi at baseline (n = 957), patients without RASi (n = 302) were younger, had a shorter duration of diabetes (7 vs. 12 years), higher estimated glomerular filtration rate (eGFR) and lower UACR, serum uric acid (sUA), body weight and systolic blood pressure. Placebo-adjusted treatment effects of dapagliflozin on UACR, eGFR, glycated haemoglobin and haematocrit over 24 weeks were similar across groups. Mean reductions in body weight and sUA were more distinct in patients without RASi treatment at baseline. CONCLUSIONS Treatment with dapagliflozin over 24 weeks provides similar clinically relevant improvements in metabolic and haemodynamic parameters, and similar reductions in UACR, in patients with T2D with elevated albuminuria treated with or without RASi at baseline.

中文翻译：

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达格列净对有或没有肾素-血管紧张素系统抑制剂治疗的2型糖尿病患者心肾危险因素的影响：事后分析。

AIMS肾素-血管紧张素系统抑制剂（RASi）是糖尿病性肾脏疾病最有效的治疗方法，但仍然存在明显的残余肾脏风险，这可能是由于与RAS无关的其他肾脏疾病进展机制所致。钠-葡萄糖共转运蛋白2抑制剂可降低蛋白尿，并可能通过提供额外的肾脏保护作用来补充RASi。这项事后分析调查了达格列净对基线或不使用RASi治疗的白蛋白尿增加的2型糖尿病（T2D）患者心肾危险因素的影响。材料和方法我们在13项安慰剂对照研究中，在基线尿尿白蛋白/肌酐比（UACR）≥30 mg / g的T2D患者中，在12-24周内评估了dapagliflozin 10 mg / day的作用。根据基线时接受或不接受RASi的治疗将患者分为两个亚组。结果与基线时有RASi的患者（n = 957）相比，没有RASi的患者（n = 302）更年轻，糖尿病病程更短（7 vs. 12岁），估计的肾小球滤过率（eGFR）和UACR较低，血清尿酸（sUA），体重和收缩压。两组之间安慰剂调整的达格列净对UACR，eGFR，糖化血红蛋白和血细胞比容的治疗作用相似。在基线时未进行RASi治疗的患者，体重和sUA的平均降低更为明显。结论达格列净治疗24周后，在代谢和血液动力学参数方面具有类似的临床相关改善，并且UACR减少类似，