#2166 Efficacy and safety of Dapagliflozin in patients with stage G4 chronic kidney disease

Abstract Background and Aims Sodium-glucose cotransporter type 2 (iSGLT2) inhibitors have become a cornerstone treatment for both diabetic and non-diabetic chronic kidney disease (CKD) due to their ability to slow the decline in glomerular filtration rate and reduce the risk of death from renal and cardiovascular causes. The benefits of iSGLT2 inhibitors seem to be independent of their blood sugar-lowering effects and may be due to their natriuretic effect, which leads to decreased intraglomerular pressure. However, there is limited data on their real-life effects, safety, and efficacy in patients with stage G4 CKD, as well as in managing other complications of renal impairment, such as anemia, hyperuricemia, and electrolyte disturbances. Our objective was evaluate the efficacy and safety of initiating Dapagliflozin treatment in patients with CKD G4, focusing on renal function, electrolyte alterations, uric acid levels, urine albumin-creatinine ratio (ACR), and hemoglobin at a one-year follow-up. Method This retrospective descriptive study followed patients who began treatment with Dapagliflozin 10 mg/day during ACKD consultations, with an eGFR of 25–30 ml/min according to the CKD-EPI formula. Over one year, we analyzed demographic data, home treatments (ISRRA and diuretics), episodes of acute kidney injury (AKI), genital infections, and serum levels of sodium (Na), potassium (K), uric acid (Au), hemoglobin (Hb), hematocrit (Hct), and albumin-creatinine ratio (ACR) at baseline, 6 months, and 12 months post-treatment. Statistical analysis was performed using SPSS 28.0 and Jamovi 2.3.28. Results A total of 75 patients were analyzed, revealing a statistically significant (P = 0.08) decrease in ACR (albumin-to-creatinine ratio), serum potassium, and an increase in hematocrit levels. Patients undergoing treatments that could directly influence the outcomes were excluded from the analysis for a more accurate comparison. No significant differences were found regarding renal function, uric acid levels, or serum sodium. There were no withdrawals by the end of the study, and no instances of acute kidney damage or genital infections were reported. Conclusion The use of Dapagliflozin seems to be safe for patients with chronic kidney disease (CKD). While there was a slight decrease in renal function, this change cannot be fully evaluated without a control group. A reduction in the rate of progression of CKD was observed, particularly in patients with CKD stage G4. Dapagliflozin appears to have a protective effect against hyperkalemia and anemia. However, a larger sample size would be necessary to confirm these findings.