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Additional renoprotective effect of the SGLT2 inhibitor dapagliflozin in a patient with ADPKD receiving tolvaptan treatment

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Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney disease (ESKD). Vasopressin plays a pivotal role in ADPKD progression; therefore, the selective vasopressin V2 receptor antagonist tolvaptan is used as a key drug in the management of ADPKD. On the other hand, sodium–glucose cotransporter-2 inhibitors (SGLT2i), which may possibly stimulate vasopressin secretion due to the diuretic effect of the drug, have been shown to have both renal and cardioprotective effects in various populations, including those with non-diabetic chronic kidney disease. However, the effect of SGLT2i in patients with ADPKD have not been fully elucidated. Herein, we report the case of a patient with ADPKD on tolvaptan who was administered the SGLT2i dapagliflozin. The patient was a Japanese woman diagnosed with ADPKD at age 30. Despite the treatment with tolvaptan, eGFR was gradually declined from 79.8 to 50 ml/min/1.73 m2 in almost 5 years and 10 mg of dapagliflozin was initiated in the hope of renoprotective effects. Although a small increase in vasopressin levels was observed, eGFR decline rate was moderated after dapagliflozin initiation. This case suggested an additional renoprotective effect of dapagliflozin in patient with ADPKD receiving tolvaptan. Although there is no evidence about the renal protective effect of SGLT2i in patients with ADPKD, we hereby report a case successfully treated with dapagliflozin for approximately 2 years. Further research, including clinical trials, is needed to evaluate whether SGLT2i are effective in patients with ADPKD.

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Funding

H.H. received lecture fee from AstraZeneca Co., Ltd., Otsuka Pharmaceutical Co., Ltd. N.T. received lecture fee from AstraZeneca Co., Ltd., research funding from Otsuka Pharmaceutical Co., Ltd.

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Authors and Affiliations

  1. Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Shun Minatoguchi, Hiroki Hayashi, Ryosuke Umeda, Shigehisa Koide, Midori Hasegawa & Naotake Tsuboi

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  1. Shun Minatoguchi
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  2. Hiroki Hayashi
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  3. Ryosuke Umeda
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  4. Shigehisa Koide
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  5. Midori Hasegawa
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  6. Naotake Tsuboi
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Contributions

Study conception and design: S.M., H.H.; Data acquisition: S.M.; Visualization: S.M.; Writing—original draft: S.M.; Writing—review and editing: S.M., H.H; Study supervision: S.K., M.H., N.T.

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Correspondence to Hiroki Hayashi.

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The remaining author has nothing to disclose.

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Due to the nature of a case report, ethics approval was not applicable.

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Written informed consent was obtained from the patient for publication of this case report and accompanying images.

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Minatoguchi, S., Hayashi, H., Umeda, R. et al. Additional renoprotective effect of the SGLT2 inhibitor dapagliflozin in a patient with ADPKD receiving tolvaptan treatment. CEN Case Rep (2024). https://doi.org/10.1007/s13730-024-00859-1

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  • DOI: https://doi.org/10.1007/s13730-024-00859-1

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