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We examined this approach in a post hoc analysis of two trials that compared dapagliflozin to placebo in patients with heart failure and reduced ejection fraction (DAPA-HF) and mildly reduced or preserved ejection fraction (DELIVER). The effect of dapagliflozin on a hierarchical composite kidney outcome was assessed, including the following: (1) all-cause mortality; (2) end-stage kidney disease; (3) a decline in estimated glomerular filtration rate (eGFR) of \u226557%; (4) a decline in eGFR of \u226550%; (5) a decline in eGFR of \u226540%; and (6) participant-level eGFR slope. For this outcome, the win ratio was 1.10 (95% confidence interval (CI)\u2009=\u20091.06\u20131.15) in the combined dataset, 1.08 (95% CI\u2009=\u20091.01\u20131.16) in the DAPA-HF trial and 1.12 (95% CI\u2009=\u20091.05\u20131.18) in the DELIVER trial; that is, dapagliflozin was superior to placebo in both trials. The benefits of treatment were consistent in participants with and without baseline kidney disease, and with and without type 2 diabetes. In heart failure trials, win statistics may provide the statistical power to evaluate the effect of treatments on kidney as well as cardiovascular outcomes.<\/jats:p>","DOI":"10.1038\/s41591-024-02941-8","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T10:02:12Z","timestamp":1714989732000},"page":"1432-1439","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["A hierarchical kidney outcome using win statistics in patients with heart failure from the DAPA-HF and DELIVER trials"],"prefix":"10.1038","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6853-7574","authenticated-orcid":false,"given":"Toru","family":"Kondo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4306-5317","authenticated-orcid":false,"given":"Pardeep S.","family":"Jhund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-2208","authenticated-orcid":false,"given":"Samvel B.","family":"Gasparyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4484-0979","authenticated-orcid":false,"given":"Mingming","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Claggett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finnian R.","family":"McCausland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Tolomeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vadagunathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiddo J. 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P.S.J. reports speakers\u2019 fees from AstraZeneca, Novartis, Alkem Metabolics, ProAdWise Communications, Sun Pharmaceuticals and Intas Pharmaceuticals; advisory board fees from AstraZeneca, Boehringer Ingelheim and Novartis; and research funding from AstraZeneca, Boehringer Ingelheim and Analog Devices Inc; P.S.J.\u2019s employer, the University of Glasgow, has been remunerated for clinical trial work by AstraZeneca, Bayer, Novartis and Novo Nordisk. He is a director of Global Clinical Trial Partners. M.Y. reports travel grants from AstraZeneca. S.B.G. is an employee and shareholder of AstraZeneca. B.L.C. has received consulting fees from Boehringer Ingelheim. F.R.M. reports research funding from the National Institute of Diabetes and Digestive and Kidney Diseases, Satellite Healthcare, Fifth Eye, Novartis and Lexicon, which is paid directly to his institution; he reports consulting fees from GSK and Zydus Therapeutics. M.V. has received research grant support, served on advisory boards or had speaker engagements with American Regent, Amgen, AstraZeneca, Bayer, Baxter Healthcare, Boehringer Ingelheim, Chiesi, Cytokinetics, Lexicon Pharmaceuticals, Merck, Novartis, Novo Nordisk, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi and Tricog Health; he sits on clinical trial committees for studies sponsored by AstraZeneca, Galmed, Novartis, Bayer, Occlutech and Impulse Dynamics. H.J.L.H. has served as a consultant for AbbVie, Astellas, AstraZeneca, Boehringer Ingelheim, Fresenius, Gilead, Janssen, Merck and Mitsubishi Tanabe; he has received grant support from AbbVie, AstraZeneca, Boehringer Ingelheim and Janssen. S.D.S. has received research grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lilly, Mesoblast, MyoKardia, National Institutes of Health\/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, Novo Nordisk, Respicardia, Sanofi Pasteur, Theracos and Us2.ai; he has consulted for Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GSK, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi Pasteur, Dinaqor, Tremeau, CellProthera, Moderna, American Regent and Sarepta. J.J.V.M. reports payments through Glasgow University from work on clinical trials, consulting and other activities from Amgen, AstraZeneca, Bayer, Cardurion, Cytokinetics, GSK, KBP Biosciences and Novartis. He reports personal consultancy fees from Alnylam Pharmaceuticals, Bayer, Bristol Myers Squibb, George Clinical PTY Ltd, Ionis Pharmaceuticals, Novartis, Regeneron Pharmaceuticals and the River 2 Renal Corporation. He receives personal lecture fees from Abbott, Alkem Metabolics, AstraZeneca, Blue Ocean Scientific Solutions Ltd, Boehringer Ingelheim, Canadian Medical and Surgical Knowledge, Emcure Pharmaceuticals Ltd, Eris Lifesciences, European Academy of CME, Hikma Pharmaceuticals, Imagica Health, Intas Pharma, J.B. Chemicals & Pharmaceuticals Ltd, Lupin Pharma, Medscape\/TheHeart.Org, ProAdWise Communications, Radcliffe Cardiology, Sun Pharmaceuticals, The Corpus, the Translation Research Group and the Translational Medicine Academy. He is a director of Global Clinical Trial Partners.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}