This study tests the hypothesis that dapagliflozin lowers proteinuria in patients with non-diabetic chronic kidney disease.
Despite optimal treatment with renin-angiotensin-aldosterone-system (RAAS) inhibitors, many patients with non-diabetic kidney disease show progressive kidney function loss, which is associated with high residual proteinuria. Novel treatment strategies are therefore required to further decrease proteinuria and to slow kidney function decline. Dapagliflozin is a sodium-glucose transport (SGLT2) inhibitor and inhibits the reabsorption of glucose and sodium in the proximal tubule. The increased natriuresis following dapagliflozin administration normalizes tubuloglomerular feedback resulting in a reduction in intra-glomerular hypertension, which is in turn manifested by acute reversible reductions in glomerular filtration rate and albuminuria. Since many etiologies of non-diabetic nephropathy are characterized by intraglomerular hypertension, we hypothesize that dapagliflozin acutely decreases GFR and proteinuria in patients without diabetes at risk of progressive kidney function loss via a glucose independent hemodynamic mechanism.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
53
Tablet
Nephrology Dept., Vancouver Coastal Health Research Institute
Vancouver, British Columbia, Canada
Division of Nephrology University Health Network, University of Toronto
Toronto, Ontario, Canada
Nephrology Unit, University Kebangsaan Malaysia
Kuala Lumpur, Malaysia
University Malaya Medical Centre, Ward 8TE
Change in 24-hr Proteinuria With Dapagliflozin for Six Weeks Relative to Placebo in Patients With Non-diabetic Kidney Disease and Proteinuria 500 mg/Day on Stable Angiotensin-converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Treatment.
bioequivalence
Time frame: 6 weeks
Effect of Dapagliflozin 10 mg/d Compared to Placebo on Glomerular Filtration Rate (GFR) Using Iohexol Clearance
bioequivalence
Time frame: 6 weeks
Effect of Dapagliflozin 10 mg/d Compared to Placebo on Systolic/Diastolic Blood Pressure
bioequivalence
Time frame: week 0, 3, 6, 12, 15, 18, 24
Effect of Dapagliflozin 10 mg/d Compared to Placebo on Body Weight
bioequivalence
Time frame: week 0, 3, 6, 12, 15, 18, 24
Effect of Dapagliflozin 10 mg/d Compared to Placebo on 6-keto-Prostaglandin F1 Alpha/Creatinine Ratio
bioequivalence
Time frame: Baseline, Week 6
Safety of Dapagliflozin vs. Placebo - the Number of Participatns With Hypoglycemic Events and/or Serious Adverse Events
safety
Time frame: week 0-26
Effect of Dapagliflozin 10 mg/d Compared to Placebo on Adenosine/Creatinine Ratio
bioequivalence
Time frame: Baseline, Week 6
Effect of Dapagliflozin 10 mg/d Compared to Placebo on Prostaglandin E2/Creatinine Ratio
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Kuala Lumpur, Malaysia
Dept Internal Medicine, division of Nephrology Hospital Group Twente
Almelo, Netherlands
Dept.of Nephrology, VU University Medical Center
Amsterdam, Netherlands
Dept. Nephrology, University Medical Center Groningen
Groningen, Netherlands
bioequivalence
Time frame: Baseline, Week 6
Effect of Dapagliflozin 10 mg/d Compared to Placebo on Thromboxane B2/Creatinine Ratio
bioequivalence
Time frame: Baseline, Week 6
Effect of Dapagliflozin 10 mg/d Compared to Placebo on PGEM/Creatinine Ratio
bioequivalence
Time frame: Baseline, Week 6
Effect of Dapagliflozin 10 mg/d Compared to Placebo on NTproBNP
bioequivalence
Time frame: Baseline (week 0, week 12), Week 6 + 18 (pooled)