Dapagliflozin in peritoneal dialysis patients: a pilot study evaluating peritoneal membrane function

Abstract

Background: Patients taking SGLT-2 inhibitors may experience delayed peritoneal fibrosis, better ultrafiltration of water and toxins, and higher survival rates. We aimed to evaluate the possible effects of Dapagliflozin in changing the peritoneal solute transfer rate, reducing peritoneal glucose absorption, and, hence, increasing ultrafiltration. Methodology: A pilot pre-post interventional study was used to evaluate 20 patients on continuous ambulatory peritoneal dialysis (CAPD) enrolled in a one-month self-controlled study [Trial#: NCT04923295]. Inclusion criteria included being over 18, and having a Peritoneal Dialysis (PD) vintage of at least six months. All participants were classified as having high or average high transport status based on their Peritoneal Equilibrium Test with a D0/D4 > 0.39. and using at least two exchanges with 2.35% dextrose over the previous three months before enrollment. Results: Following the treatment, 13 patients had an increase in median D4/D0 from 0.26 [0.17–0.38] to 0.31 [0.23–0.40], while seven patients had a decline from 0.28 [0.17–0.38] to 0.23 [0.14–0.33]. Additionally, nine patients had a decrease in median D/P from 0.88 [0.67–0.92] to 0.81 [0.54–0.85], while 11 patients had an increase from 0.70 [0.6–0.83] to 0.76 [0.63–0.91]. Conclusion: According to the findings of this study, Dapagliflozin usage in peritoneal dialysis patients did not result in a reduction in glucose absorption across the peritoneal membrane. Additionally, Dapagliflozin was also associated with a small increase in sodium dip, a decrease in peritoneal VEGF, and a decrease in systemic IL-6 levels all of which were not statistically significant. Further large-scale studies are required to corroborate these conclusions.