Dapagliflozin preserves kidney function and reduces albuminuria in children with chronic kidney disease.

BACKGROUND

Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce CKD progression in adults; but pediatric evidence remains limited. We evaluated dapagliflozin in children with non-diabetic CKD.

METHODS

In this multicenter, randomized, open-label, endpoint-blinded controlled trial, 114 children with CKD stages 1-4 were assigned to dapagliflozin plus standard care (n=58) or standard care alone (n=56) for 4 months. Primary outcomes were changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), analyzed using ANCOVA adjusted for baseline values.

RESULTS

Baseline characteristics were comparable between groups. At 4 months, eGFR increased in the dapagliflozin group (+2.1 mL/min/1.73 m²) and declined in controls (-4.2 mL/min/1.73 m²), yielding a between-group difference of 6.3 mL/min/1.73 m² (95% CI 2.1-10.5; p=0.004). UACR decreased significantly with dapagliflozin versus control (between-group difference -19.8 mg/g (95% CI: -21.9 to -18.6; p=0.002). Early CKD stages showed a shift toward lower albuminuria categories. No serious adverse events occurred.

CONCLUSION

Dapagliflozin was associated with short-term improvement in kidney function trajectory and reduction in albuminuria in children with CKD, with an acceptable safety profile.