Abstract: FR-PO0856
Efficacy and Safety of Dapagliflozin Combined with RAS Inhibitors in the Treatment of Low-Risk Idiopathic Membranous Nephropathy
Session Information
- Glomerular Diseases: Practice and New Concepts Shaping Modern Care
October 23, 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
- Ma, Hui, Department of Nephrology, General Hospital of Ningxia Medical College, Yinchuan, China
- Zhou, Xiaoling, Department of Nephrology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
Background
To evaluate the clinical efficacy and safety of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin combined with renin-angiotensin system inhibitors (RASi) in patients with low risk idiopathic membranous nephropathy (IMN).
Methods
This retrospective study included 198 cases of low risk IMN patients diagnosed by biopsy in our hospital's nephrology department (January 2020 – June 2025). After 1:1 propensity score matching (PSM), 156 patients were included and divided into RASi monotherapy (n=78) and RASi plus dapagliflozin (n=78). Changes in estimated glomerular filtration rate (eGFR) and 24h UTP at 6 months, proteinuria remission rates, adverse events, and composite renal endpoint (ESRD, sustained eGFR decline ≥30% from baseline, or initiation of corticosteroids/immunosuppressants/biologics) were compared. Kaplan–Meier curves and Cox regression were used for prognostic analysis.
Results
Baseline characteristics were well balanced after PSM. At 6 months, the combination group showed a more favorable eGFR slope (3.76 vs. −1.90 mL/min/1.73 m2 /year, P=0.002) than the RASi monotherapy group. The reduction in 24h UTP was also greater in the combination group (P=0.048). Over a median follow up of 15 (11, 26) months, the overall proteinuria remission rate was significantly higher (P=0.013) and the incidence of composite endpoint events was significantly lower (P=0.045) in the combination group. Urinary tract infection rates were similar ( P=0.677). No hyperkalemia, hypoglycemia, acute kidney injury, hypotension, or fractures occurred. Kaplan–Meier analysis showed a trend toward survival benefit with combination therapy, though not statistically significant (log rank P=0.426). Multivariate Cox regression identified higher baseline eGFR as an independent protective factor (HR=0.935, 95% , P<0.001), each 1 mL/min/1.73 m2 increase in baseline eGFR was associated with a 6.5% lower risk of endpoint events.
Conclusion
In patients with low risk IMN, RASi plus dapagliflozin reduces proteinuria, attenuates renal function decline, and improves remission rates more effectively than RASi alone, with a favorable safety profile. Higher baseline eGFR is an independent protective prognostic factor; each 1 mL/min/1.73 m2 increment confers a 6.5% risk reduction. Early combination therapy may provide greater clinical benefit.