Kidney Week

Abstract: FR-PO231

Pretreatment Extracellular Volume Expansion Predicts Body Fluid Response to SGLT2 Inhibitor in Diabetic Kidney Disease

Session Information

• Diabetic Kidney Disease: Advancing Treatment
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Ohara, Ken, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Ken Ohara,

• Masuda, Takahiro, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Takahiro Masuda,

• Morinari, Masato, Nasu Minami Hospital, Nasukarasuyama, TOCHIGI, Japan

Masato Morinari,

• Okada, Mari, Jichi Medical University Hospital, Shimotsuke, Japan

Mari Okada,

• Miki, Atsushi, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Atsushi Miki,

• Nakagawa, Saki, Jichi Medhical University, Shimotsuke, Tochigi, Japan

Saki Nakagawa,

• Murakami, Takuya, Jichi Medical University, Shimotsuke, Tochigi, Japan

Takuya Murakami,

• Oka, Kentaro, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Kentaro Oka,

• Asakura, Maki, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Maki Asakura,

• Miyazawa, Yasuharu, Nasu-Minami Hospital, Nasukarasuyama, Japan

Yasuharu Miyazawa,

• Maeshima, Akito, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Akito Maeshima,

• Akimoto, Tetsu, Department of Nephrology, Jichi Medical University, Shimotsuke, Japan

Tetsu Akimoto,

• Saito, Osamu, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Osamu Saito,

• Nagata, Daisuke, Jichi Medical University, Shimotsuke, TOCHIGI, Japan

Daisuke Nagata,

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic action. We recently reported that SGLT2 inhibitor dapagliflozin ameliorates extracellular volume expansion with a mild increase in urine volume (Nephrology 2018). However, the predictors of fluid response to SGLT2 inhibitors remain unclear.

Methods

Thirty diabetic kidney disease (DKD) patients were treated with dapagliflozin (5mg/day). Body fluid volume including intracellular water (ICW), extracellular water (ECW) and total body water (TBW) was measured on days 0 and 7 using a bioimpedance analysis (BIA) device (InBody S10). Patients were divided into low and high responders by the median value of change in the ECW/TBW for 1 week, which is a marker of extracellular volume expansion. Baseline clinical parameters were compared between the low and high responders.

Results

The body weight significantly decreased (68.0±2.8 vs. 63.0±3.2 kg, p<0.001), but the estimated glomerular filtration rate (eGFR) was not significantly changed (29.2±2.7 vs. 26.1±2.3 mL/min/1.73 m², p=0.143) after 1 week. BIA showed that the median value of the change in the ECW/TBW for 1 week was -1.2% (0.416±0.005 vs. 0.400±0.012, p=0.054). The ECW (high responders 17.0±1.2 vs. low responders 14.2±1.2 L, p=0.056), the TBW (39.8±2.6 vs. 34.8±2.6 L, p=0.093), the ECW/TBW (0.426±0.001 vs. 0.406±0.001, p=0.021) and serum brain natriuretic peptide (318±53 vs. 92±50 pg/mL, p=0.003) in the high responders were higher than in the low responders. The eGFR (24.5±3.6 vs. 33.3±3.6 mL/min/1.73 m², p=0.046) and serum albumin level (2.9±0.2 vs. 3.4±0.2 g/dL, p=0.075) in the high responders were lower than in the low responders. Significant partial correlations adjusted for the eGFR were observed between the baseline ECW/TBW and changes in the ECW/TBW (r=-0.469, p=0.009) and the TBW (r=-0.528, p=0.027).

Conclusion

Extracellular volume expansion predicts body fluid response to SGLT2 inhibitor dapagliflozin in DKD patients. This result suggests that SGLT2 inhibitor may change its diuretic action depending on the pretreatment extracellular volume status.

Funding

• Private Foundation Support