Dapagliflozin may have protective effect in adults with autosomal dominant PKD-related CKD
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Key takeaways:
- The eGFR slope improved in all but one patient not on a renin-angiotensin system inhibitor.
- In all patients, annual height-corrected total kidney volume increased, data showed.
Dapagliflozin may have a protective effect on kidney function in patients with chronic kidney disease associated with autosomal dominant polycystic kidney disease, data show.
“In [autosomal dominant polycystic kidney disease] ADPKD, [sodium-glucose cotransporter-2] SGLT2 inhibitors are expected to exert protective effects on the kidneys by reducing blood pressure, facilitating weight loss, and altering metabolism, cell signaling, and autophagy,” Masatoshi Yoshimoto, MD, of Toranomon Hospital in Tokyo, wrote with colleagues. “However, some authors have expressed concerns about the increase in kidney volume due to increased [antidiuretic hormone] ADH secretion and urine osmolality in patients with ADPKD who take these medications.”
Researchers ran a retrospective observational study from 2014 to 2023 at the nephrology center at the hospital. The study included seven patients with CKD and ADPKD treated with dapagliflozin (Farxiga, AstraZeneca).
Researchers analyzed eGFR slope and annual height-corrected total kidney volume changes before and after patients started the treatment. Investigators’ aim was to determine the effect of dapagliflozin when used concomitantly with renin-angiotensin system inhibitors.
Four patients received concomitant tolvaptan, and median observation time after starting among the total cohort was 20 months.
According to the findings, eGFR slope improved in all but one patient who did not receive a renin-angiotensin system inhibitor. In all patients, annual height-corrected total kidney volume increased, data showed. “Concurrent tolvaptan treatment had no effect,” the authors wrote.
While dapagliflozin may be effective in preventing kidney function decline in certain patient groups, Yoshimoto and colleagues wrote, “it may increase kidney volume, with a tendency toward a greater increase in patients with larger kidney volumes. Dapagliflozin should be introduced with care in patients with ADPKD, and patients should be closely monitored.”
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