Changes in body composition and handgrip strength during dapagliflozin administration in patients with chronic kidney disease

ABSTRACT Background Dapagliflozin improves renal endpoints; however, concerns exist regarding safety in patients with chronic kidney disease. We examined the effects of dapagliflozin on body composition, handgrip strength, and sarcopenia. Methods This prospective observational study included 55 patients with chronic kidney disease (type 2 diabetes, n = 27) treated with dapagliflozin 10 mg/day for 24 weeks. Handgrip strength, bio-impedance analysis-estimated skeletal muscle index, and extracellular water-to-total body water ratio were measured at baseline, 12 weeks, and 24 weeks after dapagliflozin administration. Sarcopenia was diagnosed as reduced handgrip strength (women: <18 kg; men: <28 kg) and decreased skeletal muscle index (women: <5.7 kg/m2; men: <7.0 kg/m2). Results During dapagliflozin therapy, skeletal muscle index significantly decreased from 7.51 ± 1.36 kg/m2 at baseline to 7.40 ± 1.28 kg/m2 at 12 weeks (P < 0.0001) and 7.32 ± 1.35 kg/m2 at 24 weeks (P < 0.0001). The extracellular water-to-total body water ratio decreased from 0.391 ± 0.012 at baseline to 0.390 ± 0.011 at 12 weeks (P = 0.17) and 0.389 ± 0.010 at 24 weeks (P = 0.002). Conversely, handgrip strength was unchanged from 32.9 ± 12.2 kg at baseline to 34.0 ± 12.1 kg at 12 weeks (P = 0.022) and 33.9 ± 12.4 kg at 24 weeks (P = 0.14). Sarcopenia prevalence did not change during dapagliflozin treatment [10.9% (n = 6) at baseline, 14.5% (n = 8) at 12 weeks, 10.9% (n = 6) at 24 weeks; P = 0.45. Conclusions During the 24-week dapagliflozin treatment, there was a decrease in skeletal muscle index and extracellular water-to-total body water ratio with unchanged handgrip strength in patients with chronic kidney disease. Sarcopenia prevalence remained constant. Therefore, regarding sarcopenia, short-term dapagliflozin administration might be safe. However, further long-term studies are required to determine the safety of dapagliflozin in these patients.