Abstract

Abstract Background and Aims IgA nephropathy (IgAN), a common glomerulopathy, may progress to end- stage kidney disease despite use of optimum treatment with immunosuppressants and renin- angiotensin aldosterone system antagonist. Recently, dapagliflozin (DAPA) has been shown to reduce the progression of kidney function decline in IgAN. The beneficial effects in kidney function could be because of reduction in the intraglomerular pressure. To assess the kidney function in terms of change in estimated glomerular filtration rate (eGFR) and urinary protein creatinine ratio (UPCR) with use of DAPA in patients with IgAN. Method We retrospectively collected the data of IgAN patients from our electronic database. Demographic, renal function parameters and biopsy findings were collected and compared in patients who received immunosuppression only (group I) and those who received DAPA in addition to immunosuppression (group II). Results We identified a total of 150 patients with IgAN from our database. Among these, 59 (39.3%) were managed conservatively whereas 91 (60.7%) were receiving immunosuppressive (steroid+/- mycophenolate mofetil) treatments. Among these, 67 (73.6%) received immunosuppression treatment alone (group I) whereas 24 (26.4%) patients received DAPA along with immunosuppression (group II). The mean age was 34.8±10.7 years and 36.7±9.4 years in groups I and II respectively. Proportion of males was 68.7% and 70.8% in two groups. At baseline, the renal function parameters such as serum creatinine, eGFR and UPCR as well as MEST-C scores were comparable in both the groups (p>0.05 for all three parameters). After a median follow-up of 4.9 months (IQR25-75: 1.6 to 13.4 months) in the group I, the improvement in eGFR (P = .065) and reduction in UPCR (P = .778) did not reach statistical significance. After a median follow-up of 3.9 months (IQR25-75: 1.1 to 12.3 months) in the groups II, there was non-significant improvement in the eGFR but the reduction in the UPCR was significant (median 2.6 [IQR25-75: 13 to 3.8] to 1.9 [IQR25-75: 0.7 to 2.6], P = .041). Conclusion Our initial experience in patients of IgA nephropathy suggests that the addition of DAPA to existing immunosuppressive treatment is useful in reducing the UPCR in short-term.

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