Dapagliflozin did not increase in serum K in advanced CKD in spite of initial eGFR decline

Abstract

Abstract Sodium–glucose cotransporter 2 inhibitors (SGLT2i) exhibit renoprotective effect in patients with chronic kidney disease (CKD) and do not increase serum K levels in the long term. However, it is unknown whether SGLT2i increase serum K levels in patients with advanced CKD in the short term. This study aimed to investigate the impact of SGLT2i on changes in serum K levels in patients with advanced CKD. Data of 127 Japanese patients with CKD who were newly administered 10 mg dapagliflozin in our department between August 2021 and August 2022 were analyzed. Changes in serum K and fractional excretion of K (FEK) were analyzed using multiple regression analysis. Of 127 patients, 41 were excluded. The median age was 67 years, and 70.9% were male. Overall, 24 (27.9%) patients had diabetes mellitus. The median estimated glomerular filtration rate (eGFR), serum K levels, and FEK were 35.4 mL/min/1.73 m2, 4.2 mEq/L, and 11.8%, respectively, at the time of dapagliflozin administration. Although eGFR declined to 33.2 mL/min/1.73m2 from 35.4 mL/min/1.73m2 after dapagliflozin administration (p<0.001), serum K and FEK levels increase to 4.3 mEq/L and 14.7% after dapagliflozin administration and it was not statistically significant. Dapagliflozin did not increase serum K levels in patients with advanced CKD.