En el último congreso europeo de cardiología (primera versión virtual por problemas de la pandemia COVID19) se presentaron los resultados del estudio DAPA CKD, que representa una gran novedad en el tratamiento de los pacientes con enfermedad renal crónica, que a la larga condicionan problemas cardiovasculares, diálisis y una alta mortalidad.
Un fármaco del grupo de los inhibidores del co-transportardor de sodio glucosa tipo 2 (iSGLT2) se ha evidenciado como una gran terapia para estos pacientes. Entre ellos se incluyen: Dapagliglozina, Empagliflozina y Canagliflozina.
Inicialmente son fármacos que se diseñaron para probar su eficacia en pacientes diabéticos, con buenos resultados en cuanto a reducción de hospitalizaciones por insuficiencia cardiaca y disminución de la progresión de la enfermedad renal.
Posteriormente, las acciones se vieron también en pacientes con insuficiencia cardiaca y, lo más importante, independientemente de la presencia de diabetes.
Y los últimos resultados positivos se han encontrado también en pacientes con enfermedad renal con/sin diabetes, de aquí la importancia del estudio DAPA CKD (4304 pacientes en 21 países del mundo), que comparó el uso de Dapagliflozina 10 mg vs placebo en pacientes con enfermedad renal crónica (tasa de filtración glomerular ≥25 y ≤75 mL/min/1.73m2; relación albuminuria creatinuria ≥200 mg/g y ≤5000 mg/g, recibiendo tratamiento con máxima dosis tolerada de un IECA o ARA-2 al menos 4 semanas), con un seguimiento medio de 2.4 años.
El «end-point» u objetivo primario fue la presencia de disminución sostenida y >50% en la filtración glomerular o el desarrollo de enfermedad renal terminal o muerte por causas cardiovasculares.
Este estudio apreció una reducción relativa del 44% en el deterioro de la función renal, enfermedad renal terminal, muerte de causas renales. La reducción relativa en muerte por causas cardiovasculares o insuficiencia cardíaca fue del 29%; y una reducción del 31% en la mortalidad general.
En cuanto a seguridad, hay que indicar que la dapaglifozina fue bien tolerada, sin eventos adversos destacables, sin eventos de hipoglucemia ni cetoacidosis diabética.
Así pues, este grupo farmacológico se está posicionando en el «top» de los medicamentos cardiovasculares, con efectos muy positivos tanto en pacientes con diabetes, como sin diabetes, serían fármacos órgano-protectores, esenciales en pacientes con enfermedad renal crónica, insuficiencia cardiaca con fracción de eyección reducida, independiente de la presencia de diabetes.
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