Abstract: SA-PO0843
Switching from Dual to Single Renin-Angiotensin System Blockade Plus SGLT2 Inhibitors in Patients with Chronic Glomerular Diseases
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Zanoni, Francesca, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Sikharulidze, Anna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Tedesco, Martina, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Lombardy, Italy
- Delbarba, Elisa, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Lombardy, Italy
- Mescia, Federica, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Lombardy, Italy
- Alberici, Federico, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Lombardy, Italy
- Podestà, Manuel Alfredo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Castellano, Giuseppe, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
Background
While dual renin-angiotensin system (RAS) blockade may reduce proteinuria in glomerular diseases (GD), it raises safety concerns. Recent guidelines recommend SGLT2 inhibitors (SGLT2i) with single-agent RAS blockade as reno-protective therapy in chronic GD. In this study, we evaluate the renal effects of switching from dual RAS blockade to single RAS blockade plus SGLT2i in a historical GD cohort in Italy.
Methods
We conducted a retrospective two-cohort study of adults with stable GD, defined as no active disease requiring immunosuppression. Patients had received stable dual RAS blockade for ≥6 months, then switched at baseline to single RAS blockade plus SGLT2i per guideline indication. Percent fold-change in 24-hour urine protein excretion (uPr) from baseline to 3, 6, 9, and 12 months after switch was evaluated with log-transformed paired linear models. Time-weighted uPr pre versus post switch was evaluated with paired linear models. eGFR slopes were estimated before and after switch using linear regression of eGFR over time and compared in paired linear models. All statistical analyses were site-adjusted.
Results
Among 31 patients (19 Milan, 12 Brescia), 55% had IgA nephropathy; at baseline, median eGFR was 51.0 mL/min/1.73mq, uPr 1.15 g/24h, BMI 25.1 kg/mq (Fig 1). Median follow-up time pre and post switch was 23.9 (Q1-Q3: 19.7–24.9) and 22.4 (16.7–24.7) months, respectively. uPr fold changes from baseline were +16% (95% CI -11, +52), +10% (-13, +39), +29% (+2, +63), and +25% (-14, +82) at 3, 6, 9, and 12 months, respectively. Time-weighted post-switch uPr was higher than pre-switch (post/pre ratio +1.21, 95% CI 1.03-1.44; p=0.024). Median patient-level eGFR slope changed from -3.26 to -1.24 mL/min/1.73mq/year; site-adjusted post-pre difference was +3.25 mL/min/1.73mq/year (95% CI -1.65 to 8.14; p=0.194).
Conclusion
In stable proteinuric GD, switching from dual RAS blockade to single RAS blockade plus SGLT2i was associated with modestly higher uPr and no statistically significant improvement in patient-level eGFR slope.