RENOPROTECTIVE EFFECTS OF DAPAGLIFLOZIN IN NON-DIABETIC CKD PATIENTS

Abstract

Objective: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated significant cardiorenal protection benefits in recent years, irrespective of the presence of diabetes mellitus (DM). These agents have emerged as pivotal in reducing albuminuria and impeding chronic kidney disease (CKD) progression. This study aimed to evaluate the renal effects of dapagliflozin, an SGLT2i, in in non-diabetic proteinuric patients with CKD. Design and method: In this retrospective observational study we analyzed medical records of adult non-diabetic patients with CKD, in our outpatient department over the period of one year. exhibiting albuminuria, and under stable renin-angiotensin system blockade. The primary objectives were to assess dapagliflozin's impact on estimated glomerular filtration rate (eGFR) within the first month and changes in 24-hour proteinuria from baseline. Results: Between November 2022 and December 2023, dapagliflozin was prescribed to 37 patients (8 women) with a mean age of 59.8±11.6 years. Primary diagnoses of CKD included IgA Nephropathy (7/37), other glomerulonephritis (9/37), hypertension (6/37), unknown (9/37), and other (6/37). Baseline median creatinine was 1.60±0.6 mg/dL, eGFR was 54.1±21.6 mL/min/1.73m2, and proteinuria was 1047 mg/24h (IQR 420-2170), serum potassium 4.77±0.41mEq/L blood pressure 130±15 / 82±9 mmHg, body weight 85.1±16.8 kg. After the first month, median creatinine was 1.75±0.7 mg/dL (p=0.02 vs baseline), eGFR was 50,7±21,3 mL/min/1.73m2 (p=0.006 vs baseline). Two patients experienced >30% serum creatinine increase within 4 weeks, leading to SGLT2i discontinuation. After a median follow-up of 233 days (IQR 80-284), creatinine was 1.71±0.75 mg/dL (p=0.067 vs baseline), eGFR was 51.6±23.6 mL/min/1.73m2 (p=0.019 vs baseline), and proteinuria decreased by 33,7% from baseline (450, IQR 270-1110). One patient stopped SGLT2i due to recurrent urinary tract infection. No change was observed in serum potassium, body weight and blood pressure throughout the study period. Conclusions: Treatment with dapagliflozin in non-diabetic patients with CKD reduced effectively proteinuria with an initial, reversible, decline in serum creatinine.