#2308 The effect of Dapagliflozin on albuminuria and biomarkers associated with renal function in patients with β-thalassemia and/or sickle-cell disease
Authors: Tsiotsios Konstantinos , Kalavrizioti Dimitra , Davoulou Panagiota , Kourakli Alexandra , Bratsiakou Adamantia , Velissaris Dimitrios , Papachristou Evangelos , Goumenos Dimitrios , Symeonidis Argyrios , Labropoulou Vasiliki , Papasotiriou Marios 
Published: May 2024

Abstract

Background and Aims
Patients with β-thalassemia present already from the 1st year of life with serious anemia thus needing regular blood transfusions in order to attain normal hemoglobin levels. Chronic anemia, iron overload and the use of iron chelating agents have been associated with renal dysfunction. In sickle-cell syndromes, which include sickle-cell anemia and sickle-cell trait, patients present with typical kidney functional and structural defects, resulting in urinary concentrating defects, distal nephron dysfunction and albuminuria. Sodium–glucose cotransporter-2 inhibitors (SGLT-2i) have shown beneficial effects on renal outcomes in large clinical trials with the added benefit of a substantial decrease in albuminuria. The aim of this prospective, non randomized open label study is to investigate the effect of Dapagliflozin at a dose of 10 mg daily on albuminuria and the overall progression of CKD in patients with β-thalassemia and/or sickle-cell disease undergoing regular blood transfusions.

Method
In this study we included adult patients undergoing regular blood transfusions with a baseline albuminuria of ACR&gt;30 mg/gCr (assessed with a spot urine sample) who received treatment with Dapagliflozin, a second group with no albuminuria that did not receive treatment and a group of adults with no kidney disease (Controls). In all patients renal function biomarkers were measured in urine and serum with commercial ELISA kits (NGAL and uPAR in serum, MMP9 and KIM-1 in urine), while in patients that received Dapagliflozin additional measurements of ACR and eGFR (CKD-EPI formula) were performed after 3 months of treatment initiation.

Results
In this study we included 16 patients (7 males) with β-thalassemia and/or sickle-cell disease with ACR&gt;30 mg/gCr, 35 patients (17 males) with β-thalassemia and/or sickle-cell disease without albuminuria and 20 controls (13 males). Patients that received Dapagliflozin showed a significant reduction in albuminuria three months post-initiation of treatment (ACR: 0.52 ± 1.2 vs. 0.3 ± 0.68 mg/g, p=0.006) while kidney function showed a slight non-significant reduction (eGFR: 99.3 ± 21.7 vs. 94.7 ± 28.9 ml/min/1.73m2, p=0.36). Concerning the urine and serum biomarkers of tubular dysfunction, inflammation and kidney disease progression, all were significantly increased in patients with β-thalassemia and/or sickle-cell disease in comparison to controls (Table 1). In patients that received treatment with Dapagliflozin, NGAL, MMP-9 and suPAR at 3 months post-treatment initiation did not show any significant reduction (Table 2).

Conclusion
Patients with β-thalassemia and/or sickle-cell disease show increased urine and serum levels of kidney damage biomarkers in comparison to healthy controls. Treatment of these patients with Dapagliflozin for 3 months has a significant effect in albuminuria reduction while it does not alter urine and serum levels of these biomarkers.