Safety of SGLT2 inhibitors in patients with different glomerular diseases treated with immunosuppressive therapies.

Abstract

Despite the known effects of sodium-glucose-cotransporter 2 (SGLT2) inhibitors in halting chronic kidney disease (CKD) progression and decreasing mortality from renal and cardiovascular causes, their use in patients with primary and secondary glomerular diseases maintained on immunosuppressive therapies (IST) has not yet been established. In this open-label, uncontrolled study, SGLT2 inhibitors were prescribed to patients with glomerular diseases maintained on IST to assess the safety of their use. Nine out of 17 patients had no diabetes. During a mean of 7.3months follow-up duration, the incidence rate of urinary tract infection (UTI) was 1.6 per 100 person-months. The UTI episodes were successfully treated with antibiotic therapy without the need to discontinue SGLT2 inhibitors. There were no cases of acute kidney injury (AKI), ketoacidosis, amputation, or Fournier gangrene. Moreover, markers of kidney damage such as mean serum creatinine (decreased from 1.7 to 1.37mg/dl) and mean proteinuria (urinary albumin-to-creatinine ratio decreased from 2669 to 858mg/g) improved throughout the follow-up period. SGLT2i are safe to use in patients with glomerular diseases on IST.