#3126 Combined use of SRAA blockers and SGLT2 inhibitors for reduction of proteinuria in paediatric patients with chronic kidney disease

Abstract Background and Aims To assess the reduction of proteinuria and tolerability of iSGLT2 in paediatric patients with CKD Method Retrospective observational study, patients aged 8-21 years with CKD grade 2–3 and proteinuria >0.5 mg/mg. Excluded patients with uncontrolled baseline disease, UTI in the last 3 months and orthostatic proteinuria. Dapagliflozin was administered, single daily dose of 5 mg for patients ≤30 kg and 10 mg for patients >30 kg. Statistical analysis was performed using T-student, assessing the reduction in proteinuria and its effect on glomerular filtration rate, potassium, haematocrit, changes in weight or adverse effects at 6 months. Results Six patients were studied, of whom one patient was excluded after 3 months due to comorbidities that worsened the progression of CKD. Mean age was 14.8 years, four of six were female. All with RAAS blockage, none diabetic. The most frequent diagnosis was nephrotic syndrome (50%). Mean proteinuria reduction was 42.8% (initial proteinuria 2.8 mg/mg and 1.6 mg/mg at 6 months). Mean eGFR at baseline was 72.4 ml/min/1.73 m2 and at 6 months was 112.6 ml/min/1.73 m2. Mean potassium at baseline was 4.53 mg/dL and at 6 months 4.13 mg/dL. Mean haematocrit at baseline and 6 months was 35.6% and 39% respectively. Mean weight at baseline was 46.3 kg and at 6 months 44.6 kg (3.6% reduction). No patients reported adverse effects (urinary symptoms, digestive symptoms, dyslipidaemia). Conclusion iSGLT2 is considered one of the gold standard treatments for CKD in adults. In combination with RAAS blockade, they have been shown to be effective in reducing proteinuria regardless of the underlying renal disease mechanism. In our cohort, with the combined use of RAAS blockade and iSGLT2, an added reduction in proteinuria was observed. No deterioration of renal function was observed, as described in the literature. In addition, an increase in haematocrit was observed, which may be of added value in the management of anaemia in paediatric patients with CKD, and must be monitored to avoid hyperviscosity phenomena. No adverse effects were reported with the use of iSGLT2, as demonstrated by Paige, G. and Robert, B. in 2022 in a paediatric diabetic population. Therefore, the combined use of these drugs appears to be well tolerated and effective. It is important to mention that due to the number of participants it is not appropriate to draw conclusions. Undoubtedly, this study can be a starting point for future research. We consider necessary and urgent to conduct multicentre studies.