SGLT- 2I: “CAN BE A HOPE FOR PERITONEAL DIALYSIS PATIENTS.”

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SGLT- 2I: “CAN BE A HOPE FOR PERITONEAL DIALYSIS PATIENTS.”

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Co-author 1

Kush Dev Singh Jarial kushdev.jarial@gmail.com AIIMS Vijaypur Endocrinology Jammu India -

Co-author 2

Sukhwinder Sangha drsukhi_sangha@yahoo.co.in Command Hospital Nephrology Chandigarh India -

Co-author 3

Raj Kumar Kumar rkyadavnephrology@gmail.com AIIMS New Delhi Nephrology New Delhi India -

Co-author 4

Samriti Gupta docsam03.samriti@gmail.com AIIMS Vijaypur Paediatrics Jammu India -

Co-author 5

Asheesh Kumar asheesh03.kapil@gmail.com AIIMS Vijaypur Nephrology Jammu India *

Co-author 6

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Introduction

Sodium-glucose transporter-2 inhibitors (SGLT-2i) showed promising results in slowing the progression of chronic kidney disease. The DAPA-CKD and EMPA-KIDNEY trials have provided evidence that SGLT-2i can reduce the risk of kidney failure and cardiovascular events. There are various studies in which SGLT-2i has been used in peritoneal dialysis patients but with limited followup period.

Methods

We are reporting one incident PD case in which SGLT-2i was used, and the follow-up is 35 months, giving hope for a better cardiovascular outcome.

Results

A 70-year-old male with type 2 diabetes mellitus, hypertension, and chronic kidney disease - stage 5 presented to us with uremic symptoms. With good functional status and urine output (~1200 ml/day), he was started on continuous ambulatory peritoneal dialysis after consultation with family and the patient. At baseline, his blood pressure was 168/88 mmHg with telmisartan 80 mg/day, amlodipine 10 mg /day, prazosin 10 mg/day, and torsemide 100 mg/day. Other medications were dapagliflozin 10mg/day, linagliptin 5 mg/day, sodium bicarbonate 1000 mg twice daily, insulin, atorvastatin 10mg/day, and aspirin 75 mg/day. He was initially started on continuous ambulatory peritoneal dialysis with two cycles of PD exchanges with 2 liters of 1.5% dextrose, a 4-hour cycle, and increased to thrice daily. He was a fast transporter in the peritoneal equilibrium test. Finally, he was converted to APD with 10 liters of 1.5% dextrose per day. The patient was continued on dapagliflozin, and in the last month of follow-up, he completed 35 months of follow-up. There was no hospitalization in this follow-up period.

Conclusion

As the drug is well tolerated and no adverse effects are noted in this 35-month follow-up, we may hope to use this drug in some dialysis-dependent patients. The findings in this case report need to be confirmed in a large prospective study with a longer follow-up period.

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