Efficacy and Safety of the Use of SGLT2 Inhibitors in Patients on Incremental Hemodialysis: Maximizing Residual Renal Function, Is There a Role for SGLT2 Inhibitors?

Abstract

SGLT-2i are the new standard of care for diabetic kidney disease (DKD), but previous studies have not included patients on kidney replacement therapy (KRT). Due to their high risk of cardiovascular, renal complications, and mortality, these patients would benefit the most from this therapy. Residual kidney function (RKF) conveys a survival benefit and cardiovascular health among hemodialysis (HD) patients, especially those on incremental hemodialysis (iHD). We retrospectively describe the safety and efficacy of SGLT2i regarding RKF preservation in seven diabetic patients with different clinical backgrounds who underwent iHD (one or two sessions per week) during a 12-month follow-up. All patients preserved RKF, measured as residual kidney urea clearance (KrU) in 24 h after the introduction of SGLT2i. KrU levels improved significantly from 4.91 ± 1.14 mL/min to 7.28 ± 1.68 mL/min at 12 months (p = 0.028). Pre-hemodialysis blood pressure improved 9.95% in mean systolic blood pressure (SBP) (p = 0.015) and 10.95% in mean diastolic blood pressure (DBP) (p = 0.041); as a result, antihypertensive medication was modified. Improvements in blood uric acid, hemoglobin A1c, urine albumin/creatinine ratio (UACR), and 24 h proteinuria were also significant. Regarding side effects, two patients developed uncomplicated urinary tract infections that were resolved. No other complications were reported. The use of SGLT2i in our sample of DKD patients starting iHD on a 1–2 weekly regimen appears to be safe and effective in preserving RKF.

Waitlist and post‐transplant outcomes among candidates listed for liver transplant: Liver alone versus simultaneous liver kidney listings

“…Further, assumption and carry forward of the renal function for candidates missing the renal function data for that specific week is a limitation. We were also unable to examine the effect of confounders such as SGLT‐2 inhibitors used for diabetes mellitus and their effect on renal function and patient outcomes, as the UNOS data set is limited in capturing the specific medications used for diabetes mellitus 20 . The data were also unavailable on post‐transplant sexual/reproductive health of the recipients and on pre‐transplant vaccination to assess their impact on post‐transplant outcomes.…”

SGLT2i treatment during AKI and its association with major adverse kidney events

“…Over the last decade, SGLT2is have been shown to reduce major kidney events (MAKEs) by 40% in people with or without diabetes ( Kanda and Nangaku, 2019 ; Suzuki et al, 2022 ). Whether this benefit can be extended to other more specific kidney conditions, such as kidney transplantation ( Pham and Pham, 2022 ), glomerular diseases such as IgA nephropathy, focal and segmental glomerulopathy ( Morales and Galindo, 2022 ), acute cardiorenal syndrome ( Schulze et al, 2022 ; Voors et al, 2022 ), or unusual pathologies such as Alport syndrome ( Ge et al, 2023 ), and even to people on dialysis ( Alhwiesh et al, 2022 ; De La Flor et al, 2023 ), is currently being explored. In specific scenarios, such as hospitalized critically ill patients or those with acute kidney injury (AKI), the nephrology community has been more cautious because SGLT2is are considered “sick day” drugs ( Watson et al, 2023 ), which means that during critical illness or AKI, SGLT2is should not be administered or need to be suspended due to the reasonable risk of non-hyperglycemic ketoacidosis ( Palmer and Clegg, 2021 ).…”