Dapagliflozin for rheumatic musculoskeletal disease in patients with chronic kidney disease

OBJECTIVES: To elucidate the effectiveness of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD). METHODS: We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and chronic kidney disease who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors. RESULTS: In this analysis, 43 patients were included. The average estimated glomerular filtration rate slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs -0.55 ml/min/1.73 m2/year, P = .001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to nonresponse (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dl, P = .03; 80.0 vs 38.4%, P = .01; 10.0 vs 76.9%, P < .01). CONCLUSIONS: Dapagliflozin is effective for rheumatic musculoskeletal disease patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARB and inflammation control without tacrolimus was associated with a high likelihood of favourable response to dapagliflozin.