{"title":"在托伐普坦治疗的ADPKD患者中使用达格列净:在一项回顾性研究中探索肾脏结局。","authors":"Ryunosuke Nakajima, Shun Minatoguchi, Ryosuke Umeda, Shigehisa Koide, Midori Hasegawa, Hiroki Hayashi, Naotake Tsuboi","doi":"10.1093/ckj/sfaf269","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management of chronic kidney disease, their role in autosomal dominant polycystic kidney disease (ADPKD) remains unclear.</p><p><strong>Methods: </strong>This observational study evaluated the efficacy of the SGLT2i dapagliflozin in patients with ADPKD receiving tolvaptan. The primary outcome was the chronic estimated glomerular filtration rate (eGFR) slope, modeled using a multivariable linear mixed-effect model; a within-group analysis was also performed using an interrupted time series approach.</p><p><strong>Results: </strong>A total of 48 patients receiving tolvaptan were analyzed (24 patients in the control group vs 24 patients in the dapagliflozin group). The mean follow-up duration was 649 ± 363 days across all patients. The chronic eGFR slope was -2.30 [95% confidence interval (CI) -3.47, -1.13] in the control group and -1.72 (95% CI -3.48, -0.03) mL/min/1.73 m<sup>2</sup> per year in the dapagliflozin group (<i>P</i> = .595). In within-group analysis using an interrupted time series approach, the chronic eGFR slope changed from -2.34 (95% CI -3.39, -1.30) to -1.14 (95% CI -2.68, 0.40) mL/min/1.73 m<sup>2</sup> per year following dapagliflozin initiation (<i>P</i> = .191). No serious adverse events were observed during the follow-up period.</p><p><strong>Conclusions: </strong>Although no statistically significant differences were observed, both between- and within-group analyses showed a numerically slower decline in eGFR with dapagliflozin. Importantly, no evidence of harm was observed. These findings may contribute to ongoing discussions regarding the potential role of SGLT2i in ADPKD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf269"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461144/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dapagliflozin use in tolvaptan-treated patients with ADPKD: exploring renal outcomes in a retrospective study.\",\"authors\":\"Ryunosuke Nakajima, Shun Minatoguchi, Ryosuke Umeda, Shigehisa Koide, Midori Hasegawa, Hiroki Hayashi, Naotake Tsuboi\",\"doi\":\"10.1093/ckj/sfaf269\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite the widespread use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management of chronic kidney disease, their role in autosomal dominant polycystic kidney disease (ADPKD) remains unclear.</p><p><strong>Methods: </strong>This observational study evaluated the efficacy of the SGLT2i dapagliflozin in patients with ADPKD receiving tolvaptan. The primary outcome was the chronic estimated glomerular filtration rate (eGFR) slope, modeled using a multivariable linear mixed-effect model; a within-group analysis was also performed using an interrupted time series approach.</p><p><strong>Results: </strong>A total of 48 patients receiving tolvaptan were analyzed (24 patients in the control group vs 24 patients in the dapagliflozin group). The mean follow-up duration was 649 ± 363 days across all patients. The chronic eGFR slope was -2.30 [95% confidence interval (CI) -3.47, -1.13] in the control group and -1.72 (95% CI -3.48, -0.03) mL/min/1.73 m<sup>2</sup> per year in the dapagliflozin group (<i>P</i> = .595). In within-group analysis using an interrupted time series approach, the chronic eGFR slope changed from -2.34 (95% CI -3.39, -1.30) to -1.14 (95% CI -2.68, 0.40) mL/min/1.73 m<sup>2</sup> per year following dapagliflozin initiation (<i>P</i> = .191). No serious adverse events were observed during the follow-up period.</p><p><strong>Conclusions: </strong>Although no statistically significant differences were observed, both between- and within-group analyses showed a numerically slower decline in eGFR with dapagliflozin. Importantly, no evidence of harm was observed. These findings may contribute to ongoing discussions regarding the potential role of SGLT2i in ADPKD.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 9\",\"pages\":\"sfaf269\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461144/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf269\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf269","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:尽管钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)在慢性肾脏疾病的治疗中被广泛使用,但它们在常染色体显性多囊肾病(ADPKD)中的作用尚不清楚。方法:本观察性研究评估SGLT2i达格列净在接受托伐普坦治疗的ADPKD患者中的疗效。主要终点是慢性肾小球滤过率(eGFR)斜率,采用多变量线性混合效应模型建模;组内分析也使用中断时间序列方法进行。结果:共分析了48例接受托伐普坦治疗的患者(对照组24例,达格列净组24例)。所有患者的平均随访时间为649±363天。对照组慢性eGFR斜率为-2.30[95%可信区间(CI) -3.47, -1.13],达格列净组为-1.72 (95% CI -3.48, -0.03) mL/min/1.73 m2 /年(P = .595)。在使用中断时间序列方法的组内分析中,慢性eGFR斜率从-2.34 (95% CI -3.39, -1.30)变化到-1.14 (95% CI -2.68, 0.40) mL/min/1.73 m2 /年(P = .191)。随访期间未见严重不良事件发生。结论:虽然没有观察到统计学上的显著差异,但组间和组内分析均显示,使用达格列净的eGFR下降速度较慢。重要的是,没有观察到有害的证据。这些发现可能有助于正在进行的关于SGLT2i在ADPKD中的潜在作用的讨论。
Dapagliflozin use in tolvaptan-treated patients with ADPKD: exploring renal outcomes in a retrospective study.
Background: Despite the widespread use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management of chronic kidney disease, their role in autosomal dominant polycystic kidney disease (ADPKD) remains unclear.
Methods: This observational study evaluated the efficacy of the SGLT2i dapagliflozin in patients with ADPKD receiving tolvaptan. The primary outcome was the chronic estimated glomerular filtration rate (eGFR) slope, modeled using a multivariable linear mixed-effect model; a within-group analysis was also performed using an interrupted time series approach.
Results: A total of 48 patients receiving tolvaptan were analyzed (24 patients in the control group vs 24 patients in the dapagliflozin group). The mean follow-up duration was 649 ± 363 days across all patients. The chronic eGFR slope was -2.30 [95% confidence interval (CI) -3.47, -1.13] in the control group and -1.72 (95% CI -3.48, -0.03) mL/min/1.73 m2 per year in the dapagliflozin group (P = .595). In within-group analysis using an interrupted time series approach, the chronic eGFR slope changed from -2.34 (95% CI -3.39, -1.30) to -1.14 (95% CI -2.68, 0.40) mL/min/1.73 m2 per year following dapagliflozin initiation (P = .191). No serious adverse events were observed during the follow-up period.
Conclusions: Although no statistically significant differences were observed, both between- and within-group analyses showed a numerically slower decline in eGFR with dapagliflozin. Importantly, no evidence of harm was observed. These findings may contribute to ongoing discussions regarding the potential role of SGLT2i in ADPKD.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.