An Observational Study of SGLT2 Inhibitors and Their Use in Autosomal Dominant Tubulointerstitial Kidney Disease

There are no specific treatments available for autosomal dominant tubulointerstitial kidney disease (ADTKD). As SGLT2 inhibitors have proven effective in other forms of CKD, we performed an observational study to determine their safety and effect on kidney function in ADTKD.

We obtained clinical and laboratory data before and after starting an SGLT2 inhibitor on 27 individuals with ADTKD. We created a propensity-matched cohort from a Wake Forest prospective ADTKD observational study.

Of the 27 individuals, 12 stopped medication prior to one year due to concerns about the (anticipated) acute rise in serum creatinine. There were no adverse effects. The slope of eGFR after SGLT 2 inhibitor initiation was - 2.61 ± 2.58 ml/min/1.73m², which was not significantly different from the eGFR slope prior to initiation of SGLT2 inhibitors (-3.13 ± 5.39 ml/min/1.73 m² (p = 0.71)) or from 30 propensity-matched controls (-2.25 ± 2.39 ml/min/1.73 m² (p = 0.83)). Hemoglobin and plasma and urine KIM-1 levels did not change after starting SGLT2 inhibitors.

SGLT2 inhibitors were well tolerated in ADTKD patients. There was neither a rise in hemoglobin levels nor a fall in plasma or urinary KIM-1 levels, suggesting that these agents may not be beneficial in ADTKD.