Rationale and design of the Renal Lifecycle trial assessing the effect of dapagliflozin on cardiorenal outcomes in severe chronic kidney disease
W Bakker, Hiddo J.L. Heerspink, Stefan P. Berger, Christoph Wanner, Sunil V. Badve, Clare Arnott, Alferso C Abrahams, Joost C. van den Born, Tim C van Faassen, Sandrine Gaillard, M. Gelens, José Luis Górriz, Marc H. Hemmelder, Lily Jakulj, Rob C.M. van Kruijsdijk, Dirk Kuypers, Peter van der Meer, Jeroen B. van der Net, Heleen H Nijmeijer, Marc Vervloet, Aiko P. J. de Vries, Michael Walsh, Angela Yee‐Moon Wang, Ron T. Gansevoort, the Renal Lifecycle Trial Investigators, Aaltje Y Adema, Arjan M. van Alphen, Willem A. Bax, J. Bayrak, Henk Boom, Arnold H. Boonstra, Nathan Brinkman, EF de Maar, Yvonne De Waal, Marga Eshuis, Michel P. Hermans, Dennis A. Hesselink, Ellen K. Hoogeveen, J J Huitema, W Jansen, Jacqueline T. Jonker, Sander W.M. Keet, Stefan R. A. Konings, Alexander F.L. Later, Paul Leurs, S. J. J. Logtenberg, Peter T Luik, Gürbey Ocak, Akin Özyilmaz, J W Rood, Manon Schouten, L Siddiqi-Nadery, C. E. H. Siegert, Jeroen J P Slebe, Frank Stifft, Thomas van Bemmel, G. Breda, J Van der Heijden, Joep van der Leeuw, Anita van Eck van der Sluijs, Ronald van Etten, Dominique van Mil, Femke Waanders, J S Wiegersma, Bernhard Banas, Klemens Budde, Martin Busch, Matthias Girndt, Martina Guthoff, Anna Laura Herzog, Bernd Hohenstein, Mario Schiffer, Georg Schlieper, Michael Schömig, Bernd Schröppel, Werner Seeger, Johannes Stegbauer, Frank Strutz, Christoph Wanner, Julia Weinmann‐Menke, Martin Zeier, James Holt, Shilpanjali Jesudason, Karen Keung, R. Krishnasamy, Hemant Kulkarni, Angela Makris, Rosemary Masterson, Alison E. Mather, Dharmenaan Palamuthusingam, Eugenia Pedagogos, Brendan Smyth, Vartika Srivastava, Girish Scricant Talaulikar, G. William Wong, Muh Geot Wong, Kate Wyburn, Tom Dejagere, Katrien François, Wim Lemahieu
Abstract
BACKGROUND: Several clinical trials have shown beneficial effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on kidney disease progression and cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) with and without type 2 diabetes mellitus. However, some subgroups of patients with CKD have been excluded from participation in these trials, such as patients with severely impaired kidney function, patients on dialysis and kidney transplant recipients. METHODS: The Renal Lifecycle trial (NCT05374291) is a pragmatic, international, multicentre, investigator-initiated, randomized, placebo-controlled clinical trial planned to enrol ≈1500 patients with an estimated glomerular filtration rate (eGFR) ≤25 ml/min/1.73 m2, on haemodialysis or peritoneal dialysis or after a kidney transplant and an eGFR ≤45 ml/min/1.73 m2, who will be randomized 1:1 to receive either dapagliflozin 10 mg once daily or matching placebo. RESULTS: The primary endpoint is a composite of heart failure hospitalization, all-cause mortality or, for those not on dialysis, kidney failure (start of dialysis >1 month, receiving a kidney transplant or death due to kidney failure). The trial is event driven, indicating that it will end after 468 first primary endpoint events have occurred, with a power of 80% and an α of 0.05 to detect a 25% relative risk reduction assuming an annual 12.5% incidence of the primary outcome. The secondary endpoints include a separate analysis of the incidence of each component of the primary endpoint in the overall trial population as well as the incidence of the combined primary endpoint in each of the three subgroups of patients. Other (exploratory) endpoints are efficacy, safety, tolerability, health-related quality of life and cognition. CONCLUSION: The Renal Lifecycle trial aims to investigate the effects of the SGLT2 inhibitor dapagliflozin compared with placebo on the incidence of kidney failure, heart failure, mortality and safety in three subgroups of patients with advanced CKD.