Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Oct;13(5):419-424.
doi: 10.1007/s13730-024-00859-1. Epub 2024 Mar 18.

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

Shun Minatoguchi  1 , Hiroki Hayashi  2 , Ryosuke Umeda  1 , Shigehisa Koide  1 , Midori Hasegawa  1 , Naotake Tsuboi  1
Affiliations
Case Reports

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

Shun Minatoguchi et al. CEN Case Rep. 2024 Oct.

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.

Keywords: ADPKD; PCK; SGLT2 inhibitors; Tolvaptan; Vasopressin.

PubMed Disclaimer

Conflict of interest statement

The remaining author has nothing to disclose.

Figures

Fig. 1
Fig. 1
CT imaging of the patient at diagnosis. A, B Non-contrasted CT revealed typical multiple bilateral renal cysts and liver cysts. C, D Bilateral kidneys including cysts were traced and total kidney volume was calculated using 3D-reconstruction images
Fig. 2
Fig. 2
Clinical course of the patient. eGFR estimated glomerular filtration rate, TKV total kidney volume
Fig. 3
Fig. 3
Changes in hemoglobin, hematocrit, and uric acid before and after dapagliflozin initiation. Hb hemoglobin, Hct hematocrit, UA uric acid
See this image and copyright information in PMC

References

    1. Müller R-U, Messchendorp AL, Birn H, Capasso G, Cornec-Le Gall E, Devuyst O, et al. An update on the use of tolvaptan for autosomal dominant polycystic kidney disease: consensus statement on behalf of the ERA working group on inherited kidney disorders, the European rare kidney disease reference network and polycystic kidney disease international. Nephrol Dial Transplant. 2022;37:825–39. - PMC - PubMed
    1. Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295–306. - PubMed
    1. Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou F-F, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436–46. - PubMed
    1. The EMPA-KIDNEY Collaborative Group, Herrington WG, Staplin N, Wanner C, Green JB, Hauske SJ, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388:117–27. - PMC - PubMed
    1. Afsar B, Afsar RE, Demiray A, Altay S, Korkmaz H, Yildiz A, et al. Sodium–glucose cotransporter inhibition in polycystic kidney disease: fact or fiction. Clin Kidney J. 2022;15:1275–83. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources