Dapagliflozin reduces proteinuria in IgA nephropathy patients receiving immunosuppressive therapy

Sodium-glucose cotransporter 2 inhibitors reduced proteinuria in patients with IgA nephropathy; however, their efficacy in patients at high risk of progression receiving immunosuppressive agents and renin angiotensin-aldosterone system inhibitors remains unclear. After 3 months of low-dose steroid alone or combined with mycophenolate mofetil, as well as renin angiotensin-aldosterone system inhibitors treatment, 105 biopsy-proven IgA nephropathy patients with proteinuria greater than 0.5 g/d were included in this study. The changes in proteinuria and renal function were analyzed at 3 and 6 months after initiating dapagliflozin. Among 105 patients, the MEST-C lesions of M1, E1, S1, C1, C2 and T1 were more frequent and accounted for 74.3%, 61.0%, 80.0%, 50.5%, 8.6% and 40%, respectively. Baseline characteristics were similar between 49 patients in the dapagliflozin groups and 56 patients in the control groups. After 6 months of therapy, the total remission rate in the dapagliflozin group was higher than that in the control group (55.1% vs. 33.9%, p < 0.05), the odds ratio (95% confidence interval) was 2.390 (1.085, 5.262). Besides, the median proteinuria level in the dapagliflozin group was significantly lower than that in the control group (307.92 (164.75, 616.31) mg/g vs. (505.58 (248.97, 864.96) mg/g), p < 0.05). The mean increases in serum albumin in the dapagliflozin and control groups were 2.94 g/L and 0.66 g/L, respectively (p < 0.05). Furthermore, adverse events were similar in the dapagliflozin and control groups. For IgA nephropathy patients with severe renal pathology and are being treated with low-dose steroid or combined with mycophenolate mofetil, dapagliflozin can further reduce proteinuria.