Dapagliflozin Reduces Ambulatory Arterial Stiffness Index in CKD Patients with and Without Diabetes Independently of Blood Pressure Control: Results from the GLUcose Transport and Renal PROtection in Chronic Kidney Disease (GLUTREPRO) Trial
Abstract
Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) confer cardiovascular and renal protection, but their impact on blood pressure (BP) and vascular stiffness in chronic kidney disease (CKD) is not fully defined.
Aim: To investigate the effect of dapagliflozin on 24h-BP behavior and ambulatory arterial stiffness index (AASI) as a predefined secondary outcome of the GLUTREPRO trial.
Methods: In this randomized trial, 32 patients with albuminuric CKD received dapagliflozin 10 mg/day or placebo on top of optimized standard therapy. Laboratory tests, ambulatory blood pressure monitoring (ABPM), and bioimpedance were performed at baseline and during follow-up. The study comprised a 6-month randomized phase and a 12-month open-label phase, analyzed with mixed-effects models.
Results: Baseline characteristics were balanced (mean age 58 ± 14 years, 37% diabetes, eGFR 50.6 ± 17.3 ml/min/1.73 m2, UACR 582 ± 893 mg/g). Dapagliflozin induced an early eGFR dip (-3 to -6 ml/min/1.73m2) followed by stabilization. Overall, UACR did not change significantly, but patients with baseline microalbuminuria showed lower UACR after six months versus placebo. ABPM revealed no significant differences in BP or dipping status. Conversely, dapagliflozin significantly reduced AASI at 6 months (0.50 vs. 0.62; p = 0.04), with a trend toward sustained improvement thereafter. Multivariable regression identified dapagliflozin as an independent predictor of lower AASI (β = - 0.067; 95% CI -0.130…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 32 participants or records.
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