CHANGES IN TOTAL KIDNEY VOLUME IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC DISEASE USING DAPAGLIFLOZIN.

 

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CHANGES IN TOTAL KIDNEY VOLUME IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC DISEASE USING DAPAGLIFLOZIN.

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Magdy
Elsharkawy
Magdy Elsharkawy magdi35@hotmail.com Ain Shams University Internal Medicine, and Nephrology Cairo Egypt *
Tamer Elsaid telsaid@hotmail.com Ain Shams University Internal Medicine, and Nephrology Cairo Egypt -
Shaimaa Abdelmegied nanajettan@gmail.com Ain Shams University Internal Medicine, and Nephrology Cairo Egypt -
Nourhan Hossam Eldin nor_hossam23@yahoo.com Ain Shams University Radiology Cairo Egypt -
Mahmoud Rabie mrabie@hotmail.com Ain Shams University Internal Medicine, and Nephrology Cairo Egypt -
Mostafa Abdelnasier mostafaabdelnasier@gmail.com Ain Shams University Internal Medicine, and Nephrology Cairo Egypt -
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One of the mechanisms of action of SGLT2i is increasing ketones such as β-hydroxybutyrate. The renal cyst cells in autosomal dominant polycystic kidney disease (ADPKD) seem to be metabolically inflexible. This study assessed the effect of oral dapagliflozin on the progression of  total kidney volume and chronic kidney disease (CKD) in patients with ADPKD.

An Interventional prospective study included 40 patients with ADPKD/ CKD stages II-IV. Patients were randomized into two groups: 20 patients received dapagliflozin 10 mg PO once daily, and 20 control patients. The Primary outcomes was the assessment of the progression of the sizes of renal cysts and e-GFR after 1 year of using dapagliflozin.

The change in kidney volume over 12 months:  the patients receiving dapagliflozin had a delayed progression of renal cysts. The change in renal volume in the dapaglflozin group versus the control group was (8.25 ± 3.16 mL) versus (34.75 ± 4.29 mL), with a p-value < 0.001. Also, the change in Height-Adjusted Kidney Volume was less in the dapagliflozin group (0.86 ± 0.32 mL/m) versus (3.80 ± 0.50 mL/m) in the control group (p < 0.001). Patients receiving dapagliflozin showed a significant preservation of serum creatinine and e-GFR over 12 months (1.29 ± 0.08 mg/dL) and (46.94 ± 4.41 mL/min/1.73 m²) versus the control group (1.4 ± 0.09 mg/dL) and (41.52 ± 1.52 mL/min/1.73 m²), p<0.001 and p<0.001, respectively. There was no significant difference between patients receiving dapagliflozin and the control group regarding Hematuria, loin pain, and Urinary tract infections (UTI), p-value >0.05. Serum creatinine was positively correlated at the 12th month in the dapagliflozin group to body weight, systolic blood pressure, albumin creatinine ratio, total kidney volume, and height-adjusted with p-value < 0.01. The multiple linear regression analysis showed that height-adjusted total kidney volume was an independent predictor of e-GFR decline in the dapagliflozin group at 12 month  (p 0.021).


Figure 1: Total Kidney Volume and change in Kidney Volume over 12 months in patients receiving dapagliflozin versus the control group.



The use of dapagliflozin in patients with ADPKD was associated with significant delay of renal cyst progression and preservation of renal function and e-GFR, without increasing the risk of complications over 1 year.

Kewords