Outcomes of Patients With Autosomal Dominant Polycystic Kidney Disease Prescribed SGLT2 Inhibitors in British Columbia: A Single-Arm Retrospective Cohort Study
Abstract
Background: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth leading cause of kidney failure in Canada and internationally. To date, patients with ADPKD have been excluded from trials of sodium-glucose cotransporter type 2 inhibitors (SGLT2i), which have been demonstrated to positively influence a wide range of kidney outcomes across the spectrum of chronic kidney disease (CKD). This exclusion was primarily due to theoretic safety concerns, particularly hastening disease progression due to vasopressin stimulation. As a result, there is a paucity of data on SGLT2i use among patients with ADPKD. Objectives: To estimate the risk of kidney dysfunction with SGLT2i treatment among patients with ADPKD. Design: Single-arm retrospective cohort study. Setting and patients: Adult patients (≥18 years old) with CKD with a primary diagnosis of ADPKD in British Columbia, Canada who had been exposed to any drug formulation containing empagliflozin, dapagliflozin or canagliflozin. Methods and measurements: We retrieved existing data from the province wide registry of patients with kidney disease and performed manual chart reviews on patients with ADPKD who were prescribed an SGLT2i from January 1, 2014, to December 31, 2024. The primary outcome was acute kidney injury (AKI). Secondary outcomes included eGFR slope before and after SGLT2i initiation, magnitude of “eGFR dip” after starting SGLT2i as well as the incidence of genitourinary (GU) infections requiring hospital…
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