Abstract 13678: Initial Decline in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: Insights From DELIVER
Bibliographic record
Abstract
Introduction: Among patients with heart failure with reduced ejection fraction, an initial eGFR decline >10% with dapagliflozin was associated with a lower risk of cardiovascular (CV) outcomes and slowing of kidney function decline, compared with a similar decline among those on placebo. We examined these associations in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Methods: In this prespecified analysis of DELIVER, the frequency of initial eGFR decline (baseline to month 1) was compared between dapagliflozin vs. placebo. Cox models (adjusted for baseline eGFR, age, sex, race, BMI, hypertension, left ventricular ejection fraction, log-transformed NT-proBNP, systolic blood pressure (SBP), ACEi or ARB use, MRA use, and change in SBP from baseline to month 1) were fit to estimate the association of initial >10% eGFR decline with CV (CV death or heart failure event) and kidney (≥50% eGFR decline, eGFR <15 ml/min/1.73m 2 or dialysis, death from renal causes) outcomes, landmarked at month 1, stratified by baseline diabetes. Results: The median [IQR] initial change in eGFR was -1 [-6, +5] and -4 [-9, +1] ml/min/1.73m 2 with placebo and dapagliflozin, respectively (difference 3 ml/min/1.73m 2 ; P<0.001). Patients randomized to dapagliflozin were more likely to develop an initial eGFR decline >10%, vs. placebo (odds ratio 1.9; 95%CI 1.7, 2.1). An initial eGFR decline >10% was associated with a higher risk of the CV outcome among those randomized to placebo (adjusted hazard ratio [aHR] 1.31; 95%CI 1.08, 1.59), but not to dapagliflozin (aHR 0.93; 95%CI 0.77, 1.13; P interaction =0.01; Fig. 1 ). In the dapagliflozin group, an initial eGFR decline >10% was not associated with adverse kidney outcomes (aHR 0.94; 95%CI 0.49, 1.82). Conclusions: Among patients with HFmrEF/HFpEF in DELIVER, an initial eGFR decline >10% (vs. ≤10%) was not associated with a higher risk of cardiovascular or kidney events, among those assigned to dapagliflozin.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".