Abstract: PUB082
Multiple Targets on Sodium Excretion with SGLT2 Inhibitors, Furosemide, and Spironolactone Improves Diuretic Resistance in Patients with Diabetic Nephropathy on CKD Stage 3-4: A Pilot Study
Session Information
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Author
- Liang, Wei, Renmin Hospial of Wuhan University, Wuhan, China
Background
At stage 3-4 of chronic renal disease, patients with diabetic-induced renal dysfunction are not sensitive to the conventional diuretic therapy based on loop diuretics and thiazide diuretics, leading to the earlier renal replacement at stage CKD 3-4. The lower sodium excretion could contribute to the development of diuretic resistance. The protective effects of SGLT2 inhibitors on cardiovascular is contributed by metabolic regulation and osmotic diuretic effect of glucose due to extra excretion of Glucose. The present study aims to investigate the efficacy and safety of SGLT2 inhibitors on the diuretic resistance of diabetic nephropathy at CKD 3-4 stage.
Methods
Patients with Diabetic nephropathy at CKD3-4 stage were administrated with furosemide + hydrochlorothiazide for 3 days with urine volume <1000ml, urine sodium excretion <90mmol followed by Dapagliflozin/Canagliflozin once a day for 7 days.
Results
3 male and 7 female patients with diabetic nephropathy were included, aged 51-80 years, with eGFR 60-4.6ml/min, and 3 patients presented with cardiac insufficiency. Urine volume was 800±300ml/24 hours before treatment and 2000±500ml/24 hours after treatment. Sodium excretion in urine was 80±20mmol/24 hours before treatment and 150±50mmol/24 hours before treatment. The average net weight change was -3.5±2.2kg. The Scr increased by 30%±5% before and after treatment, and the renal function in 2 patients increased by >30% after 7 days of treatment, and returned to the level of Scr before treatment after 7 days of withdrawal of Dapagliflozin/ Canagliflozin. Electrolyte levels were comparable before and after treatment.
Conclusion
The diuretic regimen based on SGLT2i could significantly improve the resistance of diabetic nephropathy patients to loop diuretics, increase urinary sodium excretion, and slightly elevate renal function in the short term without affecting blood electrolyte level. The efficacy and safety of long-term use of SGLT2i in diabetic nephropathy patients at CKD3-4 stage need further investigate in larger sample size.