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Kidney Week

Abstract: TH-PO1120

Limited Antiproteinuric Efficacy of Dapagliflozin (DPG) in Adolescents with Proteinuric CKD

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Ramakrishna, Swathi, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Sinha, Aditi, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Bagga, Arvind, All India Institute of Medical Sciences, New Delhi, Delhi, India
Background

While reducing proteinuria is renoprotective in CKD, it might persist despite renin-angiotensin-aldosterone (RAAS) blockade. SGLT2 inhibitors, known to be antiproteinuric in adult-onset CKD, have not been tested in children.

Methods

This single-center trial examined the antiproteinuric efficacy & safety of DPG in adolescents with CKD (CTRI/2022/04/042032). After written consent & baseline evaluation, consecutive eligible patients, 11-19 yr old with eGFR >45 ml/min/1.73 m2 & proteinuria >0.5 g/m2/d despite optimal RAAS blockade, received Dapavel® at 5 mg/d x 2-wk, followed by 10 mg/d x 10-wk. Biochemistry & 24-hr urine protein/albumin were repeated at 4, 8 & 12-wk, and ambulatory blood pressure at 12-wk.

Results

Of 49 screened, 25 patients (76% boys, chiefly glomerular CKD), were enrolled at median eGFR 93 ml/min/1.73 m2 & proteinuria 1.4 g/m2/d (Table 1). Fig. 1 shows outcomes at 4 & 12-wk. At 12-wk, proteinuria declined by median 1.3% and eGFR by 13.4%; 4 (16%) patients achieved the FSGS proteinuria reduction endpoint. 3 patients noted giddiness; none had serious adverse events.

Conclusion

Therapy with DPG for 12-wk has limited antiproteinuric efficacy in adolescents with CKD. Controlled studies should examine the antiproteinuric effect and optimal dose & duration of SGLT2 inhibitors in children.

Fig. 1. Outcomes at 4- and 12-wk, as median (interquartile range).