Nephro Trial Files Throwback Thursday: Dapagliflozin in CKD±T2DM, High Dialysis Dose and High-Flux Membrane in Hemodialysis, and MMF vs. CTX in Lupus Nephritis
Dapagliflozin in Patients with Chronic Kidney Disease
Heerspink HJL et al. NEJM (September 2020)
Bottom Line: This randomized controlled trial, with a sample size of 4304 patients with chronic kidney disease, evaluated the efficacy and safety of dapagliflozin (10 mg once daily) compared to placebo. The primary outcome, a composite of a sustained decline in estimated GFR, end-stage kidney disease, or death from renal or cardiovascular causes, occurred in 9.2% of the dapagliflozin group and 14.5% of the placebo group. The hazard ratio for this outcome was 0.61 (95% CI, 0.51 to 0.72; P<0.001). The known safety profile of dapagliflozin was confirmed. The study concluded that dapagliflozin significantly reduced the risk of the primary outcome compared to placebo in patients with chronic kidney disease, regardless of the presence or absence of type 2 diabetes.
Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Eknoyan G et al. NEJM (December 2002)
Bottom Line: This randomized clinical trial evaluated the effects of high-dose dialysis and high-flux dialyzer membrane on mortality and morbidity in 1846 patients undergoing thrice-weekly maintenance hemodialysis. The study found no significant difference in death from any cause between the high-dose and standard-dose groups, as well as no significant difference in other secondary outcomes. The results suggest that patients undergoing hemodialysis thrice weekly do not benefit from a higher dialysis dose or high-flux membrane.
Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis
Appel GB et al. JASN (May 2009)
Bottom Line: This multinational, two-phase study compared the efficacy and safety of mycophenolate mofetil (MMF) and intravenous cyclophosphamide (IVC) as induction treatment for active lupus nephritis. A total of 370 patients with classes III through V lupus nephritis were randomly assigned to receive either MMF (target dosage 3 g/d) or IVC (0.5 to 1.0 g/m^2 in monthly pulses) for 24 weeks, in addition to prednisone. The primary outcome was a decrease in urine protein/creatinine ratio and stabilization or improvement in serum creatinine. Results showed no significant difference in response rate between the two groups. Safety outcomes were also similar. The study did not meet its primary objective of showing superiority of MMF over IVC as induction treatment for lupus nephritis.
Nephro Trial Files Issue #NPH-2024-11
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