Ps-c27-10: short-term efficacy of dapagliflozin for chronic kidney disease patients

Background: Dapagliflozin, a SGLT-2 inhibitor, has been reported to prevent renal and cardiovascular events. Dapagliflozin has been approved for use in chronic kidney disease (CKD) without diabetes, so that it has been widely used in CKD patients. Methods: This study was a single-center, retrospective, and longitudinal study consisting of 102 patients (75% male, mean age 61.5 ± 15.7 years, 30.3% diabetes), who were started dapagliflozin prescription at our department between April 2021 and March 2022. The efficacy of treatment on proteinuria, blood pressure and blood sample findings (hemoglobin, uric acid, phosphorus and creatinine) in the short term (64.1 ± 46.7 days) between initiation of treatment and the first return visit were compared in two groups: advanced CKD (eGFR under 30 mL/min/1.73 m 2 ) and moderate CKD (GFR more than 30 mL/min/1.73 m 2 ). Results: Advanced CKD patients were older (mean age 65.1 ± 14.7 years vs. 58.2 ± 15.9 years) and had more diabetes (45.8% vs. 16.7%) compared with Moderate CKD patients, but the sex ratio was similar between the two groups. Proteinuria did not change in Advanced CKD, but decreased significantly from 2.1 ± 2.1 g/gCr to 1.8 ± 2.0 g/gCr in Moderate CKD. Systolic blood pressure significantly decreased from 144.1 ± 15.0 mmHg to 136.6 ± 26.1 mmHg in Advanced CKD and tended to decrease from 140.0 ± 17.4 mmHg to 135.4 ± 18.2 mmHg in Moderate CKD. Hemoglobin increased significantly in Moderate CKD (from 14.2 ± 1.8 g/dL to 14.7 ± 1.8 g/dL) and uric acid decreased significantly (from 6.4 ± 1.4 mg/dL to 5.4 ± 1.3 mg/dL), but no significant change was observed in Advanced CKD. On the other hand, Advanced CKD patients showed a significant increase in serum phosphorus (from 4.0 ± 1.3 mg/dL to 4.3 ± 1.5 mg/dL) and serum creatinine (from 3.2 ± 1.6 mg/dL to 3.3 ± 1.8 mg/dL). Serum creatinine elevation above 0.3 mg/dL was found in 29% of Advanced CKD patients, but not in any Moderate CKD patients. Conclusions: Dapagliflozin may reduce blood pressure and improve anemia, proteinuria, and hyperuricemia in short-term treatment of moderate CKD patients, while acute exacerbation of kidney function should be considered in short-term treatment of advanced CKD patients.