Dapagliflozin May Increase Ultrafiltration and Urine Volume in Nondiabetic Peritoneal Dialysis Patients: A Case Series Report.

INTRODUCTION: Reduced ultrafiltration in peritoneal dialysis (PD) contributes to volume overload, increasing the risk of technique failure and patient mortality. The administration of a sodium-glucose cotransporter 2 inhibitor (SGLT2i) has been shown to increase ultrafiltration volume in mice, suggesting its potential role in improving ultrafiltration. However, whether SGLT2i can improve ultrafiltration and increase urine volume in nondiabetic PD patients remains unclear. CASE PRESENTATION: We report 6 nondiabetic PD patients with a dialysis history of more than 3 months who received 10 mg of dapagliflozin once daily orally for 6 months, in addition to their conventional treatment regimens. After 6 months, clinically significant increases in ultrafiltration were observed (from 76.8 mL at baseline to 211.3 mL), and 5 patients showed increased urine volume (from 433.3 mL to 646.7 mL). The glucose concentration in the effluent dialysate was higher than that at baseline. No changes in peritoneal transport characteristics, estimated glomerular filtration rate, or residual renal creatinine clearance rate were observed at this point compared with baseline. No adverse effects, such as hypoglycemia or abnormal liver function, were reported in any of the patients. CONCLUSIONS: In this preliminary observation, dapagliflozin use was associated with increased ultrafiltration and urine volume in nondiabetic PD patients and presented a favorable safety profile. Further controlled studies are needed to confirm these preliminary findings.