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. 2023 Aug 1;18(8):1051-1058.
doi: 10.2215/CJN.0000000000000196. Epub 2023 May 25.

Pharmacokinetic Properties of Dapagliflozin in Hemodialysis and Peritoneal Dialysis Patients

Joaquim Barreto  1 , Cynthia Borges  2 , Tais Betoni Rodrigues  3 , Daniel C Jesus  1 , Alessandra M Campos-Staffico  4 , Wilson Nadruz  5 , Jose Luiz da Costa  3   6 , Rodrigo Bueno de Oliveira  2 , Andrei C Sposito  1
Affiliations

Pharmacokinetic Properties of Dapagliflozin in Hemodialysis and Peritoneal Dialysis Patients

Joaquim Barreto et al. Clin J Am Soc Nephrol. .

Abstract

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors attenuate incident cardiovascular outcomes, irrespective of baseline GFR, in conservatively managed CKD. As this condition inexorably progresses to demanding KRT, drug withdrawal is supported by the current lack of evidence of safety of SGLT2 inhibitors in dialysis.

Methods: This study was a prospective, single-center, open-label trial ( ClinicalTrials.gov identifier: NCT05343078 ) aimed at assessing the pharmacokinetic properties and safety of dapagliflozin in patients with kidney failure on regular dialysis regimens compared with those with type 2 diabetes and age- and sex-matched controls with normal kidney function. Peripheral blood samples were collected from both groups every 30 minutes for 4 hours and again after 48 hours after ingestion of dapagliflozin 10 mg, which occurred immediately before dialysis session initiation in the kidney failure group. This protocol occurred in drug-naïve patients and again after six daily doses of dapagliflozin to assess whether the drug had accumulated. The plasma and dialysate levels of dapagliflozin at each time point were determined by liquid chromatography and used to calculate pharmacokinetics parameters (peak concentration [C max ] and area under the plasma concentration-versus-time curve) for each participant.

Results: Dapagliflozin C max was 117 and 97.6 ng/ml in the kidney failure and control groups, respectively, whereas the corresponding accumulation ratios were 26.7% and 9.5%. No serious adverse events were reported for either group. Dapagliflozin recovered from dialysate corresponded to 0.10% of the administered dose.

Conclusions: In patients with kidney failure on dialysis, dapagliflozin was well tolerated, was slightly dialyzable, and had nonaccumulating pharmacokinetic properties.

Clinical trial registry name and registration number: Pharmacokinetics and Dialyzability of Dapagliflozin in Dialysis Patients (DARE-ESKD 1), NCT05343078.

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Conflict of interest statement

T.B. Rodrigues reports employment with Synvia. A.C. Sposito reports advisory or leadership roles for Bayer, Libbs, Merck, Novartis, and Novo Nordisk and speakers bureau for AstraZeneca, Bayer, Libbs, Merck, Novartis, and Novo Nordisk. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Concentration-versus-time curve of dapagliflozin (left) and D3OG (right) after single- (day 1) and multiple-dose (day 7) protocols in the kidney failure group. D3OG, dapagliflozin 3-O-glucuronide; Dapa, dapagliflozin.
Figure 2
Figure 2
Dapagliflozin plasma concentration-versus-time curves of kidney failure versus control groups after a single dose (left) and multiple doses (right).
Figure 3
Figure 3
D3OG plasma concentration-versus-time curves of kidney failure versus control groups after a single dose (left) and multiple doses (right).
See this image and copyright information in PMC

Comment in

References

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