From June 5-8, 2021, the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) held its 58th Annual Virtual Meeting. Due to COVID-19, the meeting was held fully online. However, that did not prevent experts in the field from gathering to discuss new research, treatment, and ideas. According to Endocrinology Advisor, one such presentation (LB003) centered around dapagliflozin, which has shown to have protective effects for patients with chronic kidney disease (CKD). According to data analysis regarding the Phase 3 DAPA-CKD clinical trial, researchers also determined that dapagliflozin shows similar protection for patients with focal segmental glomerulosclerosis (FSGS). In fact, the treatment could help slow FSGS progression.

Dapagliflozin

According to MedLine Plus, dapagliflozin, sometimes sold under the brand name Farxiga, is:

in a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors. It lowers blood sugar by causing the kidneys to get rid of more glucose in the urine.

Typically, dapagliflozin is used for patients with type 2 diabetes or certain types of heart failure. However, researchers have recently been learning that it could also potentially benefit patients with certain renal conditions.

Within this presentation, researchers discussed data analysis from the DAPA-CKD study. Within the subgroup analysis, there were 115 patients with FSGS. Of these, 53 received dapagliflozin and the remainder received a placebo. Altogether, the median trial follow-up was 2.4 years. Findings included:

• During the study, patients who received dapagliflozin experienced slower FSGS progression than those who received a placebo. Additionally, there was a slower decline in estimated glomerular filtration rate (eGFR).
• Altogether, dapagliflozin was relatively safe and well-tolerated.
• Additionally, patients receiving dapagliflozin were less likely to have adverse kidney or cardiovascular reactions, had a lower mortality risk, and had a lower need for dialysis.

Ultimately, the research highlights the potential benefits of using dapagliflozin within this patient population. Additionally, the researcher suggested that patients with FSGS could benefit from dapagliflozin use in conjunction with other therapies, such as angiotensin receptor blockers or ACE inhibitors.

Focal Segmental Glomerulosclerosis (FSGS)

Focal segmental glomerulosclerosis (FSGS) is a rare kidney disease in which scar tissue forms on the glomeruli, or areas of the kidneys which filter waste. Ultimately, this causes protein to leak into the urine and prevents adequate kidney function. There are three main forms of FSGS. In primary FSGS, there is no known cause. Next, secondary FSGS can result from a number of other conditions, such as obesity, obstructive sleep apnea, lupus, or kidney defects. Finally, gene mutations cause familial FSGS. Typically, FSGS affects males slightly more than females. Additionally, FSGS often affects those of African-American background more than other racial or ethnic groups.

Patients with early-stage FSGS may be asymptomatic, meaning that they present no symptoms. However, as symptoms appear, they include:

• Proteinuria (excess protein in the urine)
• High creatinine levels and low blood albumin levels
• Swelling around the eyes, hands, feet, and abdomen
• High cholesterol
• Unintended weight gain (due to excess fluid)
• High blood pressure
• Foamy urine
• Appetite loss

FSGS may also lead to a condition called nephrotic syndrome, which negatively impacts the kidneys.