Observational study found a numerically slower eGFR decline with dapagliflozin in ADPKD patients, suggesting SGLT2 inhibitors may have a role.
Background Despite the widespread use of sodium glucose cotransporter 2 inhibitors (SGLT2i) in the management of chronic kidney disease, their role in autosomal dominant polycystic kidney disease (ADPKD) remains unclear. Methods This observational study evaluated the efficacy of the SGLT2i dapagliflozin in patients with ADPKD receiving tolvaptan. The primary outcome was the chronic eGFR slope, modeled using a multivariable linear mixed-effect model; a within-group analysis was also performed using an interrupted time series approach. Results A total of 48 patients receiving tolvaptan were analyzed (24 patients in the control group vs. 24 patients in the dapagliflozin group). The mean follow-up duration was 649 ± 363 days across all patients. The chronic eGFR slope was -2.30 (95% CI: -3.47, -1.13) in the control group and -1.72 (95% CI: -3.48, -0.03) ml/min/1.73m2 per year in the dapagliflozin group (p = 0.595). In within-group analysis using an interrupted time series approach, the chronic eGFR slope changed from -2.34 (95% CI: -3.39, -1.30) to -1.14 (95% CI: -2.68, 0.40) ml/min/1.73m2 per year following dapagliflozin initiation (p = 0.191). No serious adverse events were observed during the follow-up period. Conclusions Although no statistically significant differences were observed, both between- and within-group analyses showed a numerically slower decline in eGFR with dapagliflozin. Importantly, no evidence of harm was observed. These findings may contribute to ongoing discussions regarding the potential role of SGLT2 inhibitors in ADPKD.
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Nakajima et al. (2025) studied this question.
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