#2495 Renal and peritoneal protective effects of SGLT2 Inhibitors in incident peritoneal dialysis (PD) patients

Abstract Background and Aims The renoprotective effect of SGLT2 inhibitors has been evaluated in several large studies, but renal function of the subject is defined as eGFR≥20-30 mL/min/1.73 m2 or higher in most studies. On the other hand, SGLT2 is expressed in the peritoneum, and there have been reports of decreased glucose absorption and improvement of ultrafiltration injury with SGLT2 inhibitors in animal studies. However, there are very few reports on the protective effects of SGLT2 inhibitors on renal and peritoneal function in PD patients. In the present study, we retrospectively evaluated the renal and peritoneal protective effects of SGLT2 inhibitors in patients undergoing PD. Method Among the patients who received PD at our hospital, 8 patients who continued SGLT2 inhibitors and underwent peritoneal equilibrium testing (PET) at the time of induction and 1 year after induction were assigned to the SG group, and 32 patients who received PD without SGLT2 inhibitors were assigned to the control group. PET data, PD drainage volume, urine output, renal • peritoneal • total Kt/V, and renal • peritoneal • total weekly CCr at the time of PD induction and 1 year after PD induction were compared retrospectively. Results Among the 40 patients, the median age was 64 years (interquartile range 52-71), with 33% males, and the median eGFR at PD induction was 5.25 ml/min/1.73 m2. The most common cause of end-stage renal failure was diabetic nephropathy (37.5%), followed by chronic glomerulonephritis (15.0%) and nephrosclerosis (12.5%). At the time of induction of peritoneal dialysis, there were no significant differences between the SG group and the control group in PET data, PD drainage volume, urine output, renal • peritoneal • total Kt/V and weekly CCr. However, at one year after PD induction, urine volume, renal • total Kt/V, and renal weekly CCr were higher in the SG group. Total weekly CCr at 1 year of PD induction was significantly higher in the SG group (p = 0.03). Multivariate linear regression analysis showed that SGLT2 inhibitors were independently associated with total weekly CCr at 1 year after PD induction (p = 0.04). Conclusion Our results suggest that SGLT2 inhibitors may have renal and peritoneal protective effects in patients undergoing PD induction. For CKD stage G4 and 5 patients scheduled for PD induction in the future, proactive continuation of SGLT2 inhibitors may be effective in preserving renal and peritoneal function.