The use of SGLT2 Inhibitors in Peritoneal Dialysis Patients: a Shade of Light on Dapagliflozin
Author(s): Abdullah K Alhwiesh, Ibrahiem Saeed Abdul-Rahman, Mohammed Ahmad Nasreldin, Abdelgalil Moaz Mohammed, Suzan Al-Oudah, Reem Al-Thwainy1, AyatAlAwal, Zahra Alsenpisi, Abdulla Abdulrahman, Sarah Al-Wa
Objectives: This article reviews the clinical and experimental data pertaining to the renal effects of SGLT2 inhibition with a particular focus on Dapagliflozin in ESRD-peritoneal dialysis patients.
Methods: Fifty type-2 diabetes patients on insulin were treated with automated peritoneal dialysis (APD), with addition of selective SGLT2 inhibitor dapagliflozin to the anti-diabetic medication. The change in peritoneal transport status (PTS) was judged by Peritoneal Equilibration Test (PET) for patients before and after Dapagliflozin use. Ultrafiltration volume and the residual renal function were recorded as well. The primary outcomes were: 1. change of the PTS with Dapagliflozin therapy, 2. Change of the mean Ultrafiltration volume (UF), 3. Change in the mean 24-hour urine volume, 4. Follow-up of the inflammatory markers in both serum and PD fluid.
Results: There was no change in PTS, but there were significant changes in insulin requirements (p = 0.0262), fasting blood sugar (p = 0.0210), hemoglobin A1-C (p =0.0265), urine volume (p < 0.001), ultrafiltration volume (p < 0.01), mean systolic blood pressure (p = 0.0431), body weight (p = 0.0337) and serum uric acid (p =0.0341). Although there was marginal augmentation of the 24-h urine uric acid, yet the change was not significant (p = 0.073). On the other hand, we did not observe significant changes in blood urea nitrogen, serum creatinine, 24-h urine creatinine clearance, Kt/V and urine protein.
Conclusion: The use of Dapagliflozin was not associated with change of the peritoneal transport status. Dapagliflozin enhances diabetic control, and its use in PD patients with type-2 diabetes mellitus was useful in improving the UF and average urine volumes. In addition, it seems that such treatment decreases most of the inflammatory markers, both in the serum and PD effluent. Dapagliflozin did not affect the creatinine clearance or proteinuria, but it may have some hypouricemic effect, its pathogenesis needs further investigations.