Dapagliflozin use in tolvaptan-treated patients with ADPKD: exploring renal outcomes in a retrospective study

Background. Despite the widespread use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management of chronic kidney disease, their role in autosomal dominant polycystic kidney disease (ADPKD) remains unclear. Methods. This observational study evaluated the efficacy of the SGLT2i dapagliflozin in patients with ADPKD receiving tolvaptan. The primary outcome was the chronic estimated glomerular filtration rate (eGFR) slope, modeled using a multivariable linear mixed-effect model; a within-group analysis was also performed using an interrupted time series approach. Results. A total of 48 patients receiving tolvaptan were analyzed (24 patients in the control group vs 24 patients in the dapagliflozin group). The mean follow-up duration was 649 ± 363 days across all patients. The chronic eGFR slope was –2.30 [95% confidence interval (CI) –3.47, –1.13] in the control group and –1.72 (95% CI –3.48, –0.03) mL/min/1.73 m² per year in the dapagliflozin group (P = .595). In within-group analysis using an interrupted time series approach, the chronic eGFR slope changed from –2.34 (95% CI –3.39, –1.30) to –1.14 (95% CI –2.68, 0.40) mL/min/1.73 m² per year following dapagliflozin initiation (P = .191). No serious adverse events were observed during the follow-up period. Conclusions. Although no statistically significant differences were observed, both between- and within-group analyses showed a numerically slower decline in eGFR with dapagliflozin. Importantly, no evidence of harm was observed. These findings may contribute to ongoing discussions regarding the potential role of SGLT2i in ADPKD.