SGLT2 new treatment for CDK; anyone on them?

[RoxanneKidney]

I was listen to a Dr. in a podcast regarding new treatment for CDK. Even though these sodium inhibitors are used for heart patience and diabetics, they are showing promising results for non-diabetics with CKD and proteinuria.

"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.

"SGLT2 INHIBITORS IMPROVE CV OUTCOMES ALSO IN NON-DIABETIC PATIENTS WITH HF The first large Phase 3 trial of SGLT2 inhibitors enrolling non-diabetic patients in addition to diabetics was the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial."

[Blackknight1989]

Here is a January 2019 study originally in pubmed and reprinted in the link.

Link:

dom-pubs.onlinelibrary.wile...

[RoxanneKidney in reply to Blackknight1989]

Thanks! my doctor said I could try it. She recommended dapagliflozin 10mg daily. Anyone else on an SGLT2? Sounds like it is good for diabetics and CV patients too.

[My_Kidneys in reply to Blackknight1989]

Thank you for the article. I am always interested in what the expert research scientists have to say about ckd.

[userotc]

Thanks for the info (and thanks Blacknight for the link) which Ive saved. Its an option for my mum with her proteinuria but we are averse to drugs so are trying natural first, including methods mentioned on this forum.

The comment at the end of the report's conclusion "without clear evidence of additional safety concerns" didnt allay my concerns much to be honest! But please keep us posted.

[Ziggydoodah in reply to userotc]

I have very high levels of proteinuria and non diabetic. What natural things has your mum been doing? I have been following a plant based diet for the past 2 weeks, feeling so much better, although obviously I won't know if there is any improvement, until I get my bloods done in October. I have also been eating flaxseeds, which I have read helps with proteinuria. I have normal potassium levels. Cheers.

[userotc]

She has continually sought to improve her diet and wellbeing including low-carb and moderate-low protein. Also she's been taking cordyceps supplement for 1 month. Some/all of these options were discussed on here recently (links below) and I know you actively participated at least in the 2nd link stating that diet wasnt working for you.

Youll note from my post on link 2 yesterday that urine data have continued to worsen (except total protein) whilst serum data have continued to improve. Im still to answer the discrepancy between total urinary protein halving whilst 24h protein output nearly doubled.

Any ideas? We also communicated similarly in 3rd link below and your 24h data were much better than mum's but you didnt know your total protein. I presume that's still the case?

Im currently wondering if the discrepancy could somehow be peculiar to those with 1 kidney (like mum); see possible complications at the end of kidneyresearchuk.org/kidney.... If I dont resolve soon, I may do a new post for others' experiences and hope I dont just get answers suggesting ask her nephrologist as he just largely ignores urine data, saying all good (with serum data)!.

healthunlocked.com/nkf-ckd/...

healthunlocked.com/nkf-ckd/...

healthunlocked.com/nkf-ckd/...

[Sparker88]

Great to know. Thanks for sharing!

[taiglum]

Hi Roxanne I have been on Dapa for 6 months now. i am diabetic and these were supposed to help. It hasn't changed my diabetes numbers and my gfr has fallen from 61 to 14. i feel these pills have something to do with the big drop in my gfr but my nephrologist disagrees so i'm still taking them.

[Darlenia in reply to taiglum]

Hi Taiglum. So sorry to hear this. So many are trying to find the magic cure for diabetes. My husband is a T2D and his numbers also plummeted practically overnight, putting him on dialysis. Stunning. In his case, he was taking a new blood pressure medicine which seemed to prompt it. When hubby asked his nephrologist about this, the nephrologist indicated that he doubted it and that, "Sometimes kidneys just do that. They simply quit." Diabetes is nasty. It takes out blood vessels everywhere - inside eyes, kidneys, etc. There is no restoring the circulatory system to where it was before. My sense is that, whether due to medication or normal aging, when certain key blood vessels have had enough, they simply go. I wish diabetes was taken more seriously a lot earlier. Hubby's mom, when told about her impending diabetes, promptly dieted and never went on meds. She lived well into her 80s. Her son, my dear hubby, was in denial through most of it and has paid the price. Harsh disease - T1D even more so than T2D. It desperately needs a cure.

[RoxanneKidney in reply to taiglum]

There is a big drop in GFR shortly after you take them, but it should be no more than 30 percent. Then it should come up and stablize. So if you Dr. kept you on the pills, that make me wonder. How long has it been down? If you stop the pills it is supposed to come back up. But that is a HUGE drop. How do you feel otherwise? Six months is a long time for it to stay down!!

[RoxanneKidney in reply to RoxanneKidney]

Ride out the drop. I just watched 10 more videos on these drugs ..stay the course. It is the only hope we have had in 20 years.

[RoxanneKidney in reply to RoxanneKidney]

I'm going to try myself.

[taiglum in reply to RoxanneKidney]

Well now the Dr. is preparing me for dialysis. This is not where I thought I'd be a short year ago. Hopefully it helps some people but for me it has destroyed my kidneys I think. Be very careful with these drugs.

[RoxanneKidney in reply to taiglum]

Which one were you on dapagliflozin? Considering the studies were done by the drug companies, I'm sceptical too.

[RoxanneKidney in reply to RoxanneKidney]

I just saw it was Dapa. Sorry this happened.

[RoxanneKidney in reply to RoxanneKidney]

Just curious. Did you have the COVID shots?

[Bassetmommer NKF Ambassador]

HI Roxanne,Just curious who did the podcast, who was on it? My husband was put on Forxiga last month. He is stage 3 but has issues with his diabetes. He has highs very easily. Since he went on this SLGT2, his sugars are soooooo much better and he feels great. He went off metformin which I feel is poison.

I too went on a GLP-1 inhibitor last week. I went on it even though my diabetes is well controlled (A1c of 5.9). I went on it for the heart and kidney protection and the main reason is to lose weight. We will see what happens but they feel that the protectiveness of these drugs is way advanced and the risk minimum.

[RoxanneKidney in reply to Bassetmommer]

Keep us posted

[RoxanneKidney in reply to Bassetmommer]

It was a podcast with a kidney association group and not about the new inhibitors but the issue came up and the nephr sang their praises

[RoxanneKidney in reply to Bassetmommer]

There are a handfull of youtube videos describing how the meds work and panel discussions on the study.

[RoxanneKidney in reply to RoxanneKidney]

youtube.com/watch?v=3Qb2Chu...(Not working as expected?) The study was funded by the drug company...but here is a professor explaining it.

[IgANChris]

Spoke to my doctor at my last appointment about this since another nephrologist running a clinical trial I'm in had recommended it. He's ok with me taking it but wanted me to read up on the potential side effects just so I understand the possible issues. I have my next appointment this Tuesday and we're going to discuss it again but he sounds like he's on board if I am.

[RoxanneKidney in reply to IgANChris]

The side effects suck. I don't need weight loss or yeast infections, or my bp lowered any more so after reading up, I'll pass.

[RoxanneKidney in reply to RoxanneKidney]

They said the side effects happen about 50 percent of the time according to Drugs.com etc. I was reading through them, but most were for high sugar not CKD

[RoxanneKidney in reply to RoxanneKidney]

I just watched 10 more videos on these drugs. I have to try them. Unfortunately we don't have anything else.

[IgANChris]

I definitely understand the concern about the side effects. I'm mostly paying attention to the yeast infection (I didn't realize males could get it too), but the necrotizing fasciitis is a scary sounding one also, although it sounds extremely rare. I lot of these are more common in people with diabetes, so I'm not sure if that is because the body chemistry is different as a result of the disease, or just simple math in that they don't have a big enough sample size yet of non-diabetic kidney disease patients.

I'm still leaning towards trying it at least, but I'll certainly be discussing the side effects with my nephrologist when I see him.

[RoxanneKidney]

From what I found on the videos, the infections are rare, and like you said mostly found in those people who were diabetic or had an issue with the sugar to begin with. The placebo groups got them too. Not sure about the necrotizing fasciitis...OMG I didn't come across that one. LOL. Yeah, not sure about that either. My biggest concern is that this Lisinopril is already lowering my bp to 96/59 etc. and to add the SGLT 2, ...damn. Plus, I honestly don't thinkI can drink more water. Already drinking 64 oz and that is enough. Prior to the lisinopril I took a diuretic, thinking that I JUST had high bp...so I was dehydrated all the time. I don't want to take more meds. Least if I don't have too. So I want to make my gut bateria as healthy as possible. Honestly, my GFR began to decrease around the age of 50 when a.) My periods stopped b.) I stopped smoking weed.

Ironically I stopped smoking weed when my stress level increased. Weed has been shown to help glaucoma by lowering the bp in the eyes...bet it does in the kidneys too. I'm just trying to think why I lived so long with this untreated protein issue. HAHA...it had to have been the weed. So I haven't tried the SGLT2/DAPA yet, still debating on how I progress...My sister who is a PA and prescribes meds, told me that it is her theory not to mess with something that is already working. And this Lisinopril seems to be working, so not sure what to do.