Effect of SGLT2i on Cardiovascular Biomarkers in Patients With Type 2 Diabetes and CKD Stage 3b-4

Study Overview
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Brief Summary
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This is a prospective, observational study to assess the effect of SGLT2 inhibitors on surrogate markers of kidney and cardiovascular health in patients with stage 3b and 4 chronic kidney disease (CKD). This study includes three clinic in person visits and weekly telephone visits for 12 weeks. Recruit 28 patients with CKD stages 3b-4 and follow up for 12 weeks Determine the effect of interventions on the primary outcome variable serum klotho measured by immunoprecipitation-immunoblot

Official Title
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Effect of SGLT2i on Cardiovascular Biomarkers in Patients With Type 2 Diabetes and CKD Stage 3b-4

Conditions
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Kidney Disease, Chronic, Diabetes

Intervention / Treatment
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* Drug: SGLT2 inhibitor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-80 years of age All races and ethnicities All genders Type 2 diabetes mellitus History of hypertension defined as > 130 or > 80 mmHg or normotensive on pharmacologic therapy Estimated glomerular filtration rate (GFR) (CKD Epi equation) of 15-44 ml/min/1.73 m2 (Stages 3b-4 CKD) Urinary albumin creatinine ratio of > 200 mg/g <5000mg/g Ability of study participant or legally authorized representative to provide informed written consent Able to maintain stable dose of any vitamin D and any calcium supplements for 180 days post randomization. Exclusion Criteria: Autosomal dominant or autosomal recessive polycystic kidney disease, lupus nephritis or anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis Receiving cytotoxic therapy, immunosuppressive therapy or other immunotherapy for primary or secondary renal disease within 6 months prior to enrolment History of organ transplantation Receiving therapy with a sodium glucose co-transporter 2 (SGLT2) inhibitor within 8 weeks prior to enrolment or previous intolerance of an SGLT2 inhibitor Type 1 diabetes (T1D) Active use of SGLT2 inhibitor History of persistent hypercalcemia (serum total Calcium > 10.5 mg/dl) Body mass index > 45 kg/m2 Active on kidney transplant list Inability to provide informed consent Any condition outside the renal and cardiovascular disease area, such as but not limited to malignancy, with a life expectancy of less than 2 years based on investigator´s clinical judgement Active malignancy requiring treatment at the time of screening (with the exception of successfully treated basal cell or treated squamous cell carcinoma). Hepatic impairment (aspartate transaminase [AST] or alanine transaminase [ALT] >3x the upper limit of normal [ULN]; or total bilirubin >2x ULN at time of enrolment) Women of child-bearing potential (ie, those who are not chemically or surgically sterilized or who are not post-menopausal) who are not willing to use a medically accepted method of contraception that is considered reliable in the judgment of the investigator or women who have a positive pregnancy test at enrolment or randomization or women who are breast-feeding Participation in another clinical study with an investigational product (IP) during the last month prior to Enrolment Inability of the patient, in the opinion of the investigator, to understand and/or comply with procedures and/or follow-up OR any conditions that, in the opinion of the investigator, may render the patient unable to complete the study. Patients who cannot complete the patient reported outcome (PRO) assessments can still participate in the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 1<br>Group 1: take prescribed SGLT2i after baseline visit. | Drug: SGLT2 inhibitor<br>* Participants will ingest a standard dose of SGLT2i prescribed by the standard of care physician.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in serum klotho levels at 6 weeks | Change in serum klotho levels in participants with advanced Diabetic Kidney Disease (DKD) at 6 weeks are measured by immunoprecipitation-immunoblot. | Baseline, 6 weeks | 
| Change in serum klotho levels at 12 week | Change in Serum klotho levels in participants with advanced Diabetic Kidney Disease (DKD) at 12 weeks are measured by immunoprecipitation-immunoblot. | Baseline, 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in serum magnesium levels at 6 weeks | Mean change from baseline in serum magnesium levels at 6 weeks is measured. Serum magnesium levels are measured by measuring the level of magnesium in the blood. | Baseline, 6 weeks | 
| Change in serum magnesium levels at 12 weeks | Mean change from baseline in serum magnesium levels at 12 weeks is measured. Serum magnesium levels are measured by measuring the level of magnesium in the blood. | Baseline, 12 weeks |