New Drugs For CKD Can Effectively Protect Kidney Function And Prolong Life

The results of the DapagliflozinPrevention of Adverse Outcomes-Chronic Kidney Disease (DAPA-CKD) study werejust presented at the 2020 European Society of Cardiology Annual Meeting. Theresults showed that dagaglizin,one of new drugs for CKD, could further reducethe incidence of renal deterioration, renal and cardiovascular death by 39% andthe all-cause mortality by 31% on the basis of standard treatment. These dataare expected to revolutionize current treatment standards in this population ofpatients with kidney disease, providing newer and better treatment options forpatients with chronic kidney disease.

A landmark study

This study is a phase 3 clinicaltrial of dapagliflozin in the treatment of kidney disease, and a total of 4304patients with kidney disease were enrolled. The glomerular filtration rate ofthe patients tested was between 25 and 75, and all of them had been adequatelytreated with puri/sartans. Among them, 32.5% of the patients were notaccompanied by diabetes. The patients were randomly divided into two groups:dapagliflozin group and placebo group. The dapagliflozin group received onetablet of dapagliflozin daily, and the placebo group received placebo treatment.Neither the doctor nor the patient knew who was taking dapagliflozin or aplacebo during the process (double-blind). Follow-up is planned to end when 681patients have reached the endpoint, the primary composite endpoint of worseningrenal function (defined as a sustained ≥50% reduction in glomerular filtrationrate, or development of uremia), or renal or cardiovascular death. Asoriginally planned, the study was expected to take four years. However, after amedian follow-up of only 2.4 years, the study was terminated early in March2020 due to the overwhelming efficacy of the dapagliflozin treatment group.

The results show that for patientswith renal insufficiency who have not progressed to uremia, regardless ofwhether they are accompanied by type 2 diabetes, compared with placebo, the newdrugs for CKD, called dapagliflozin, can further reduce the composite endpoint(worsening renal function, cardiac vascular or renal death risk) by 39%,significantly reducing the risk of all-cause death by 31%.

How can a hypoglycemic drug treatkidney disease

The kidney-protecting effect ofLiejing drugs is twice that of sartan drugs, which cannot be completelyexplained by hypoglycemic. The DAPA-CKD study also confirmed that the benefitof dapagliflozin treatment was the same regardless of whether the patient haddiabetes. The kidneys are involved in the onset of diabetes, and the treatmentcan also be carried out through the kidneys. Dapagliflozin is a class of drugsknown as "sodium glucose transporter 2 inhibitor". In the renaltubules of our kidneys, there is a protein called "sodium glucosetransporter", which is responsible for reabsorbing the sugar and sodium inthe renal tubules back into the body, preventing blood sugar from being lost. Thisprotein is divided into type 1 and type 2. Among them, type 2 reabsorbed sugaraccounts for 90% of diabetic patients, and sodium glucose transporter 2 absorbsmore sugar than healthy people. If we find a way to inhibit the sodium glucosetransporter 2 and prevent it from reabsorbing so much sugar, the sugar can beexcreted through the kidneys, which achieves the effect of lowering bloodsugar. Liejing drugs can excrete about 80g of glucose per day (without causinghypoglycemia), which is equivalent to taking away the calories of two steamedbuns or a bowl of rice, so as to achieve the effect of weight loss. At the sametime, the drugs can lower blood pressure. When blood sugar and sodium areexcreted, the intraglomerular pressure will be reduced, the feedback of theglomerulus will be restored, and the process of renal failure will be sloweddown, so as to achieve the effect of protecting the kidney. In addition, thekidney-protecting effect of Liejing drugs is also manifested in improving renaltissue hypoxia, reducing renal inflammation and fibrosis, and reducing urinaryprotein and protecting renal function through multiple pathways.

Nine years ago, Liejing drugs cameout as hypoglycemic drugs, and they were still not very promising hypoglycemicdrugs at that time. However, in just a few years, great changes have takenplace. The advantages of such new drugs for CKD have sprung up like mushroomsafter a spring rain, and they have become the best hypoglycemic drugs. They arealso no longer just hypoglycemic drugs. Dapagliflozin has been out of thecircle and has become a kidney-protecting drug and an anti-heart failure drug.At present, there are other new drugs for CKD, such as empagliflozin andcanagliflozin. Although their progress is a little slower, there are frequentreports of good news in many disease areas, and even lecithin drugs areexpected to become a new type of antihypertensive medicine.