From the Guidelines
SGLT2 inhibitors should be considered for patients with polycystic kidney disease (PKD) who have reduced kidney function, particularly those with an eGFR between 25-90 mL/min/1.73m², as they may provide renoprotective benefits by reducing intraglomerular pressure, decreasing hyperfiltration, and potentially slowing cyst growth through metabolic effects, as supported by the most recent guideline evidence 1. When initiating these medications, monitor for side effects including genital mycotic infections, urinary tract infections, and volume depletion. Patients should be advised to maintain adequate hydration and practice good genital hygiene. Dose adjustments are necessary for declining kidney function, and these medications should be avoided when eGFR falls below 25 mL/min/1.73m². Some key points to consider when using SGLT2 inhibitors in patients with PKD include:
- Medications like empagliflozin (10-25mg daily), dapagliflozin (10mg daily), or canagliflozin (100-300mg daily) may be used.
- While SGLT2 inhibitors were initially developed for diabetes management, their kidney-protective mechanisms appear beneficial in non-diabetic kidney diseases including PKD, though specific large-scale trials in PKD populations are still emerging.
- These medications may complement other PKD treatments like tolvaptan by addressing different pathophysiological mechanisms of disease progression. The use of SGLT2 inhibitors in patients with PKD is supported by recent clinical practice guidelines, which recommend their use in adults with chronic kidney disease, regardless of the degree of kidney dysfunction and albuminuria 1.
From the Research
Considerations for Using SGLT2 Inhibitors in Patients with PKD
- The use of Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors in patients with Polycystic Kidney Disease (PKD) is a topic of interest due to their potential renoprotective benefits 2, 3.
- However, patients with PKD were excluded from pivotal trials, and there is a lack of clinical efficacy data and potential disease-specific safety concerns 2, 3.
- Preclinical studies have shown conflicting results, with some suggesting that SGLT2 inhibitors may exacerbate cyst growth and others indicating potential benefits 3, 4.
- A case report suggested that the SGLT2 inhibitor dapagliflozin may have an additional renoprotective effect in a patient with ADPKD receiving tolvaptan treatment 5.
- The current evidence suggests that SGLT2 inhibitors may be beneficial in reducing the risk of kidney failure and major cardiovascular events in patients with chronic kidney disease and diabetes, but their effects in patients with PKD are uncertain 6.
Potential Benefits and Risks
- Potential benefits of SGLT2 inhibitors in patients with PKD include:
- Renoprotective effects
- Cardiovascular protection
- Reduced risk of kidney failure
- Potential risks and uncertainties include:
- Exacerbation of cyst growth
- Disease-specific safety concerns
- Lack of clinical efficacy data
- Uncertain effects on eGFR, amputation, and fracture
Future Research Directions
- There is a need for adequately powered clinical trials to examine the effects of SGLT2 inhibitors in patients with PKD 2, 3.
- Further research is needed to evaluate the potential benefits and risks of SGLT2 inhibitors in patients with PKD and to determine their safety and efficacy in this population 5, 6.