EFFECT OF DAPAGLIFLOZIN AT 12 MONTHS ON KIDNEY FUNCTION IN PATIENTS WITH GLOMERULAR DISEASE IN THE MAINTENANCE PHASE OF THE POPULATION OF THE REGIONAL GENERAL HOSPITAL 46 OF THE MEXICAN INSTITUTE OF SOCIAL SECURITY

Introduction:

Chronic kidney disease has a high worldwide prevalence; in Mexico it is among the first 10 causes of mortality. Proteinuria is an important marker to predict the risk of kidney disease progression. Treatment with iSRAA to control high blood pressure and antiproteinuric therapy has represented the cornerstone to slow the progression of kidney disease; however, the use of these drugs has not been sufficient to stop significant proteinuria in a wide variety of glomerular diseases. SGLT2i have shown in numerous trials in patients with diabetes mellitus an association between the reduction of albuminuria and greater long-term renal survival; however, in subanalysis these drugs have been given to patients with glomerulopathies without diabetes mellitus, who have shown a reduction of proteinuria and progression of kidney disease. However, the antiproteinuric efficacy of SGLT2i is poor. Furthermore, the use of these drugs reduces the risk of MACEs or CHF regardless of the degree of protenuria or GFR.

Methods:

To evaluate the effect of dapagliflozin on renal function in the maintenance phase in patients with glolmerular disease of HGR No.46 of the IMSS.

Retrospective, longitudinal, analytical, comparative study of patients with glomerular disease under follow-up at the nephrology outpatient clinic of HGR No.46 who received dapagliflozin as part of their maintenance treatment and control group without dapagliflozin

Results:

A total sample of 80 patients was collected, of which 40 patients were distributed in the control group with standard management and a group to which dapagliflozin 10 mg orally every 24 hours was added. The most frequent cause was the focal and segmental sclerosis glomerulus pattern with a total sample of 63 patients (78.8%) and in young patients with an average age of 35.5 years in both groups. At the beginning of the study, the patients in the control group had Cr S of 1.46 ± 0.6 mg/dl, at 12 months of follow-up an increase in Cr S was observed to 1.62 ± 0.79 mg/dl and at 24 months with an increase in Cr S at 2.09 ± 2.06 mg/dl. In the dapagliflozin group, patients had a SCr of 1.76 ± 0.6 mg/dl, at 12 months a SCr of 1.76 ± 0.65 mg/dl was maintained and at 24 months it was 1.85 ± 0.65 mg/dl. A multivariate repeated measures analysis was performed to investigate the effect of dapaglifozin on creatinine over time. The use of dapaglifozin was found to be significant (Wilks' Lambda = .614, p = .030). In the control group, a net loss of eGFR of 8.7 ml/min/1.73m2SC was obtained at 24 months of follow-up, while in the dapagliflozin group, a net eGFR loss of 6.4 ml/min/1.73 m2SC was obtained in 24 months of follow-up, which is equivalent to a decrease in eGFR loss of 26.4% per year. In the dapagliflozin group showed a reduction in proteinuria of 23.3%. There were 6 patients who progressed to renal support therapy, all in the control group (p=0.039). Only one death reported in the control group

Conclusions:

We report for the first time the renal outcomes in patients with non-diabetic glomerulopathy and use of dapagliflozin compared to a control group, in a Mexican population in the west of the country. We found that the use of dapagliflozin showed a reduction in the progression of chronic kidney disease, demonstrated by serum creatinine values and estimated glomerular filtration rate.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.