Abstract: PO1307
A Cohort Study of Patients with Autosomal Dominant Tubulointerstitial Kidney Disease (ADTKD) Started on SGLT-2 Inhibitors
Session Information
- Genetic Diseases of the Kidneys: Non-Cystic - I
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Genetic Diseases of the Kidneys
- 1002 Genetic Diseases of the Kidneys: Non-Cystic
Authors
- Bleyer, Anthony J., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Kidd, Kendrah O., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Ainsworth, Hannah C., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Robins, Victoria C., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Taylor, Abbigail, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Martin, Lauren, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Kim, Alice, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Sabbisetti, Venkata, Harvard Medical School, Boston, Massachusetts, United States
- Langefeld, Carl D., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Kmoch, Stanislav, Univerzita Karlova 1 lekarska fakulta, Praha, Praha, Czechia
Background
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been shown to slow estimated glomerular filtration rate (eGFR) decline in chronic kidney disease (CKD) but have not been tested in patients with ADTKD. We performed a prospective nested cohort observational study and analyzed changes in eGFR and kidney injury marker 1 (KIM-1) in patients who were prescribed SGLT2i by their physicians.
Methods
We obtained baseline and follow-up laboratory studies at 1 week, 1 month, and 4 months after starting an SGLT2i and compared eGFR with baseline function. We also obtained information about adverse events.
Results
12 individuals were started on SGLT2i by their physicians, with 10 on emapliflozin, 2 dapagliflozin. Table 1 shows the changes in eGFR and KIM-1. For patients with eGFR > 30, mean eGFR increased at 1 month by 3 ml/min. At four months, eGFR was 3 ml/min below baseline (-18.5% due to low baseline eGFR). For eGFR > 30, eGFR decline was 12% from baseline at one month and 8% from baseline at 4 months. Plasma KIM-1 was unchanged, but urinary KIM-1 increased by 100%. One patient stopped empagliflozin at his request after 8 weeks due to decline in eGFR of 14% from baseline. No other adverse events noted. Two patients have been treated for 6 months with stable eGFR
Conclusion
The change in eGFR after treatment with SGLT2i was consistent with prior studies of CKD. The plasma KIM-1 was unchanged, but the rise in urinary KIM-1 was very concerning. Further study is required to determine if these agents are beneficial in ADTKD. An additional 4 months of follow up will be presented at ASN.
Changes in eGFR and KIM-1 in ADTKD Patients Taking SGLT2 Inhibitors
| Baseline | 1 week | 1 month | 4 months | |
| Mean ± Standard Deviation [count] | ||||
| eGFR < 30 (ml/min/1.73m2) | 22.7±4.5 [3] | 21.7±3.2 [3] | 25.9±7.1 [2] | 19.3±5.5 [2] |
| eGFR ≥ 30 (ml/min/1.73m2) | 42.2±12.1 [9] | 37.7±11.2 [6] | 34.9±10.5 [8] | 34.7±8.6 [6] |
| Median Plasma KIM-1 (pg/ml) | 195.72 [12] | 203.74 [12] | - | |
| Median Urine KIM-1 (pg/mg UCr) | 2017.9 | 3395.1 [12] | - | |
| Percent Mean* Change from Baseline. | ||||
| eGFR < 30 (ml/min/1.73m2) | - | -4.1% | 5.1% | -18.5% |
| eGFR ≥ 30 (ml/min/1.73m2) | - | -5.9% | -11.6% | -7.9 % |
| Plasma KIM-1 (pg/ml) | - | 1.1% [12] | - | |
| Urine KIM-1 (pg/mg UCr) | - | 103% [12] | - | |
*Mean was computed as the average change in eGFR for each individual (at time point), compared to their baseline measurement.
Funding
- NIDDK Support