Dapagliflozin attenuates progression from prefrailty to frailty in patients with hypertension and chronic kidney disease.
Pasquale Mone, Davide Viggiano, Antonella Pansini et al.
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In 30 seconds
DAPA-FORTRESS followed prefrail hypertensive adults aged over 65 years with chronic kidney disease (CKD) for 1 year to examine links between renal measures and physical performance, and whether dapagliflozin was associated with frailty progression. This clinical trial report used coarsened exact matching, leaving a balanced cohort of 105 patients, including 52 receiving dapagliflozin. Greater albuminuria and lower eGFR were associated with poorer physical performance. In adjusted analyses, dapagliflozin use was associated with lower odds of progression to frailty at 1 year (OR = 0.130; CI 0.045-0.381; P < 0.001).
Key findings
- Gait speed was inversely associated with albuminuria (r2 = 0.48, P < 0.0001) and positively associated with eGFR (r2 = 0.18; P < 0.0001).
- Patients with eGFR <60 mL/min/1.73 m2 had worse physical performance than those with higher eGFR (P = 0.0003).
- Dapagliflozin use was independently associated with lower odds of frailty progression at 1 year (OR = 0.130; CI 0.045-0.381; P < 0.001).
Why it matters
The findings connect markers of kidney injury with physical performance in older adults who have both hypertension and CKD, and suggest that frailty progression may be a relevant outcome when assessing this population. The observed association with dapagliflozin supports further attention to functional outcomes alongside renal measures, while not establishing that the drug caused the lower progression risk.
What to keep in mind
The matched cohort included 105 patients, and the reported dapagliflozin association was based on adjusted observational analyses rather than a stated randomised comparison; residual confounding cannot be excluded.