Abstract: SA-OR065

Effect of Sodium-Glucose Cotransporter 2 Inhibitor on Fluid Distribution: Comparison with Furosemide and Tolvaptan

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

  • Ohara, Ken, Jichi Medical University, Oyama, Tochigi, Japan
  • Asakura, Maki, Jichi Medical University, Oyama, Tochigi, Japan
  • Sugase, Taro, Jichi Medical University, Oyama, Tochigi, Japan
  • Onishi, Akira, Jichi Medical University, Oyama, Tochigi, Japan
  • Akimoto, Tetsu, Jichi Medical University, Oyama, Tochigi, Japan
  • Saito, Osamu, Jichi Medical University, Oyama, Tochigi, Japan
  • Muto, Shigeaki, Jichi Medical University, Oyama, Tochigi, Japan
  • Nagata, Daisuke, Jichi Medical University, Oyama, Tochigi, Japan
  • Masuda, Takahiro, Jichi Medical University, Oyama, Tochigi, Japan
  • Murakami, Takuya, Jichi Medical University, Oyama, Tochigi, Japan
  • Imai, Toshimi, Jichi Medical University, Oyama, Tochigi, Japan
  • Nakagawa, Saki, Jichi Medical University, Oyama, Tochigi, Japan
  • Okada, Mari, Jichi Medical University, Oyama, Tochigi, Japan
  • Yoshizawa, Hiromichi, Jichi Medical University, Oyama, Tochigi, Japan
  • Miki, Atsushi, Jichi Medical University, Oyama, Tochigi, Japan
  • Oka, Kentaro, Jichi Medical University, Oyama, Tochigi, Japan
Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new antihyperglycemic drug that increases urinary glucose excretion. Recently, the diuretic property of SGLT2 inhibitors has been reported, but the effect on fluid distribution remains unclear. We therefore examined the change of fluid distribution after the administration of SGLT2 inhibitor dapagliflozin (DAPA), and compared with loop diuretic furosemide (FR) and vasopressin V2 receptor antagonist tolvaptan (TLV).

Methods

Forty chronic kidney disease (CKD) patients with fluid retention (average eGFR 29.0±3.3 mL/min/1.73 m2) were enrolled in this study. The patients were divided into the three groups: DAPA (n=15, dose 5 mg/day), FR (n=15, dose 55.7±12.4 mg/day) and TLV (n=10, dose 7.5 mg/day). The fluid volume was measured using a bioimpedance analysis (BIA) device day 0 and 1 week after the administration. One-way ANOVA was performed to measure differences between the groups.

Results

After 1 week, changes in body weight (DAPA -3.1±0.8, FR -4.6±0.8, TLV -2.6±1.0 kg, p=0.22) and urine volume (+81±220, +451±243, +187±230 mL/day, p=0.52) were not significantly different among the groups. BIA showed changes in intracellular water (-6.2±1.3, -7.3±1.2, -7.1±1.4 %, p=0.82) were similar among the groups, and changes in extracellular water (ECW) tended to increase in FR (-8.5±1.6, -12.6±1.6, -7.9±1.8 %, p=0.10). Changes in the ratio of ECW to total body water (ECW/TBW) were significantly different (-1.3±0.5, -3.4±0.5, -0.3±0.6 %, p<0.001). Changes in estimated glomerular filtration ratio were not significantly different during the treatment (-2.0±3.3, 3.9±3.3, 0.4±4.1 %, p=0.46).

Conclusion

SGLT2 inhibitor dapagliflozin predominantly decreases ECW, but the reduction rate of ECW/TBW differs from furosemide and tolvaptan. These results indicate that SGLT2 inhibitor has a novel property on fluid distribution not found in conventional diuretics.

Funding

  • Government Support - Non-U.S.