Dapagliflozin administration for 1year promoted kidney enlargement in patient with ADPKD.

Abstract

To date, there is insufficient evidence regarding use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for patients with autosomal-dominant polycystic kidney disease (ADPKD), as such cases have been excluded from previous clinical trials exploring the kidney protection effects of such medications. Here, findings of an ADPKD patient who received dapagliflozin, a selective SGLT2 inhibitor, for 1year are presented. A 38-year-old woman with a family history of ADPKD wished for treatment with dapagliflozin. After starting administration at 10mg/day, total kidney volume (TKV) continued to increase, from 1641 to 1764mL after 84days and then to 2297mL after 340days. The estimated glomerular filtration rate (eGFR) was also decreased from 67.3 to 56.2mL/min/1.73m2, and then to 51.4mL/min/1.73m2 at those times. Immediately after discontinuation of dapagliflozin, TKV and eGFR were slightly improved to 2263mL and 55.1mL/min/1.73m2, respectively. Following a review of basic research studies, we consider that increased intratubular urinary osmotic pressure, compensatory glucose reabsorption by sodium-glucose cotransporter-1 in the late proximal tubule, and hypertrophy shown in collected cells caused by increased vasopressin may be associated with ADPKD disease progression. Caution may be needed when administering dapagliflozin to patients with ADPKD.