Effect of SGLT2i on cardiac remodeling in patients with chronic kidney disease undergoing peritoneal dialysis

Abstract

Listen

Translate article

Abstract Background/Introduction Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) are one of the cornerstone therapies for cardiorenal protection in chronic kidney disease (CKD). However, its use has been restricted in patients with very low glomerular filtration rates (GFR). Therefore, evidence of their use in patients with renal replacement therapy (RRT) is limited. Recent data suggest the positive impact of SGLT2i on cardiac remodeling parameters measured by echocardiogram in patients with heart failure.(1) The use of SGLT2i could be beneficial in patients with CKD undergoing peritoneal dialysis as their cardiovascular risk is high and therapies are limited in such scenarios. Purpose Our aim was to evaluate changes in echocardiographic parameters of cardiac remodeling in patients with CKD and peritoneal dialysis after the use of SGLT2i. Methods Retrospective analysis of a prospective cohort of patients with KDIGO stage 5 CKD receiving peritoneal dialysis. Echocardiographic parameters were measured prior to the introduction of SGLT2i and at a median follow-up of 6.6 months after the initiation of SGLT2i. Results 11 patients were included, mean age was 69.2 years [9.2] , women represented 36.3% of the total and 54.6% of them had a history of congestive heart failure (HF) admission. (Table 1). The mean left ventricular ejection fraction was preserved (54% [9.9]) but subclinical damage was evident by GLS (-13.8% [4.5]). Left Atrial (LA) dilatation and dysfunction were frequent in the basal study, with a mean LA volume index maximum (LAVI max) of 42 ml/m2 [33.1-66.8] and LA reservoir strain of 20.9% [10.6] (Table 2). In the follow-up studies, there was a non-significant trend towards a reduction in LA volume at the expense of LAVI reservoir (-7.1ml/m2; p=0.09). However, there was no improvement regarding LA and LV function parameters. The medication was safe and well tolerated, no new HF admissions occurred during the follow-up. Conclusions Patients with CKD and peritoneal dialysis have echocardiographic signs of atrial enlargement and dysfunction, as well as subclinical LV damage, with reduced GLS. A non-significant trend of LAVI reservoir reduction was observed with the use of SGLT2i and medication was well tolerated. Larger studies are necessary. Table 1. Baseline characteristics Table 2. Echocardiographic parameters