Effects of Dapagliflozin on Health-Related Quality of Life in Patients with CKD.

Abstract

In patients with CKD with and without type 2 diabetes, treatment with dapagliflozin slowed the decline in health-related quality of life. The effect was particularly evident on physical health–related quality of life, symptom burden, and the effect of kidney disease. Treatment with the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin attenuates progression of kidney disease and reduces the risks of heart failure and death in patients with CKD. Data on the effects of dapagliflozin on health-related quality of life (QoL) are limited. Adults with CKD, with and without type 2 diabetes, with eGFR 25–75 ml/min per 1.73 m² and urinary albumin-to-creatinine ratio 200–5000 mg/g were randomized to dapagliflozin (10 mg/d) or placebo. We assessed health-related QoL using the Kidney Disease Quality of Life Instrument 36 (KDQOL-36) questionnaire at baseline and at 12, 24, and 36 months. In this prespecified analysis, we determined the overall effects of dapagliflozin versus placebo. A total of 4032/4304 (94%) randomized participants (mean age 62 [12] years, 32% female) had information on KDQOL-36 at baseline. Mean scores on the physical health composite (PHC), mental health composite (MHC), and kidney disease symptoms, effects, and burden were similar between randomized groups at baseline. During a median follow-up of 2.3 (interquartile range, 1.9–2.6) years, mean scores were significantly higher in participants randomized to dapagliflozin for PHC (0.71 [95% confidence interval (CI), 0.30 to 1.31]), MHC (0.62 [95% CI, 0.14 to 1.11]), kidney disease symptoms (1.33 [95% CI, 0.57 to 2.10]), kidney disease effects (1.34 [95% CI, 0.43 to 2.26]), and kidney disease burden (1.46 [95% CI, 0.30 to 2.62]). Participants randomized to dapagliflozin were significantly less likely to experience a clinically meaningful (≥10 units) decline in PHC relative to placebo (hazard ratio, 0.84 [95% CI, 0.74 to 0.96]). Corresponding hazard ratios for ≥10-unit decline in MHC and kidney disease symptoms, effects, and burden were 0.95 (95% CI, 0.85 to 1.07), 0.84 (95% CI, 0.75 to 0.94), 0.84 (95% CI, 0.72 to 0.97), and 0.93 (95% CI, 0.84 to 1.02), respectively. In participants with CKD with and without type 2 diabetes, treatment with dapagliflozin slowed the decline in physical health, reduced worsening of symptoms, and lessened the effect of kidney disease. Dapagliflozin and Prevention of Adverse Outcomes in CKD, NCT03036150. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2025_11_11_ASN0000000776.mp3