Abstract: TH-PO1215
Short-Term Effects of an SGLT2 Inhibitor on Divalent Ions in Patients with ADPKD: The SIDIA Trial
Session Information
- Late-Breaking Research Posters
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Genetic Diseases of the Kidneys
- 1201 Genetic Diseases of the Kidneys: Monogenic Kidney Diseases
Authors
- Roth, Lorena, City Hospital Zurich Triemli, Zurich, Switzerland
- Harmacek, Dusan, UniversitatsSpital Zurich, Zurich, Switzerland
- Schachtner, Thomas, UniversitatsSpital Zurich, Zurich, Switzerland
- George, Britta, UniversitatsSpital Zurich, Zurich, Switzerland
- Hofmann, Cornelia, Zurcher Fachhochschule, Zurich, Switzerland
- Georgalis, Argyrios D., Cantonal Hospital Graubunden, Chur, Switzerland
- Venzin, Reto Martin, Cantonal Hospital Graubunden, Chur, Switzerland
- Hofmann, Patrick, Cantonal Hospital Graubunden, Chur, Switzerland
- Fehr, Thomas, Cantonal Hospital Graubunden, Chur, Switzerland
Background
SGLT2 inhibitors (SGLT2i) are a cornerstone of CKD therapy, lowering progression, CV events, and mortality. ADPKD patients were excluded from major trials, and data on electrolyte handling with SGLT2i, especially with tolvaptan, are lacking.
Methods
SIDIA was a mechanistic, randomized, double-blind, placebo-controlled, two-period crossover trial in 15 ADPKD patients (mean eGFR 68, age 43). They received empagliflozin 10 mg or placebo for 14 days with washout. Primary endpoints were 24-h urinary phosphate, calcium, magnesium; secondary endpoints included other electrolytes, inflammation, vitamin D metabolism, tolerability, and safety. Treatment effects were analyzed with a generalized linear mixed model.
Results
No significant differences were seen in 24-h urinary phosphate, calcium, or magnesium with empagliflozin vs. placebo (26 vs. 22.9 mmol/d, p=0.21; 4.0 vs. 2.3, p=0.56; 4.6 vs. 4.3, p=0.18). Empagliflozin lowered uric acid (–26%), increased serum magnesium (+5.7%) and urinary citrate (+79%), and reduced BP (–4/–7 mmHg). A small, expected dip in eGFR (–7.1%) was noted; urine volume 4.6 vs. 3.8 L, with no safety signals.
Conclusion
In ADPKD patients with and without tolvaptan, short-term empagliflozin was safe, showing no significant effects on urinary calcium, phosphate, or magnesium. Increased serum magnesium, along with higher urinary citrate and lower uric acid, may provide long-term benefits by slowing disease progression and reducing stone and gout risk.
Baseline characteristics
| Characteristics | Participants, N= 15 |
| Age, years | 43 (6, 51.5) |
| Sex, men (%) | 8 (53) |
| Body mass index kg/m2 | 26.3 (6.9) |
| eGFR, ml/min per 1.73m2 body surface area | 68.0 (20.2) |
| Tolvaptan, n (%) | 7 (47) |
| Hypertension | 10 (67) |
atient characteristics: categorical as n (%); continuous as mean (SD) or median (IQR)
Forest plot of empagliflozin vs. placebo on primary outcomes. Medians (IQR) and treatment effects from a GLMM crossover are shown with 95% CIs. Analyses used two-sided tests (α=0.05). GLMM, generalized linear mixed model.
Funding
- Commercial Support – Boehringer Ingelheim, Vontobel Foundation