Among the pleiotropic effects of sodium glucose cotransporter 2 inhibitors (SGLT2i), dapagliflozin reduces serum uric acid in patients with advanced chronic kidney disease (CKD), a new study finds.
In a retrospective study, 121 Japanese patients with stage 3-5 CKD not on dialysis received 10 mg dapagliflozin daily. Approximately a third of patients had diabetes, and 28% patients overall were female.
With dapagliflozin treatment, serum uric acid levels declined from a median 6.4 to 5.6 mg/dL in patients with stage 3-4 CKD, regardless of sex, Masafumi Yamato, MD, of Sakai City Medical Center in Osaka, Japan, and colleagues reported in Scientific Reports. Fractional excretion of uric acid increased from 6.8% to 9.3%, 6.3% to 8.2%, and 7.4% to 9.6% in patients with CKD stage 3a, 3b, and 4, respectively. The rate of increase in uric acid excretion did not correlate with the rate of serum uric acid decrease.
Change in estimated glomerular filtration rate did not account for the findings. Approximately 70% of serum urine is excreted into the urine and the remaining 30% may be excreted into the intestinal tract. The investigators suggested that intestinal excretion of uric acid may be involved in the results. The study lacked information on patients’ diet.
“The renoprotective effect of SGLT2i may not be due to lowering of urinary protein alone, as one of the pleiotropic effects of SGLT2i is reduction of serum [serum uric acid] levels, which may lead to cardiac and renal protection,” Dr Yamato’s team wrote.
How SGLT2is reduce serum uric acid levels remains unclear. It is still unknown whether uric acid reduction by SGLT2is can improve renal outcomes, such as CKD progression and end-stage kidney disease. Further studies are needed.
Iwata Y, Notsu S, Kawamura Y, Mitani W, Tamai S, Morimoto M, Yamato M. The effect of dapagliflozin on uric acid excretion and serum uric acid level in advanced CKD. Sci Rep. 2023 Mar 24;13(1):4849. doi:10.1038/s41598-023-32072-y