Dapagliflozin Therapy in Non-Diabetic Patients with Microalbuminuria

Indications and Eligibility Criteria

• The European Society of Cardiology recommends dapagliflozin for non-diabetic patients with chronic kidney disease and an estimated glomerular filtration rate (eGFR) ≥ 25 ml/min/1.73 m² to slow the progression of kidney disease and reduce cardiovascular risk 1, 2
• The presence of microalbuminuria (albumin-to-creatinine ratio > 3 mg/mmol) is a risk factor for kidney disease progression and justifies the use of dapagliflozin, as seen in patients with a ratio of 4.5 mg/mmol 3

Therapeutic Benefits and Considerations

• Dapagliflozin provides cardiovascular protection, reducing the risk of hospitalization for heart failure 1
• The American Diabetes Association and the National Kidney Foundation recommend optimizing blood pressure control, with a target ≤ 130/80 mmHg in the presence of microalbuminuria, and using an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi or ARB) in patients with microalbuminuria 3, 4, 5
• Lifestyle modifications, including a low-sodium diet (< 2g/day), maintaining a body mass index (BMI) between 20-25 kg/m², quitting smoking, and regular physical exercise, are recommended 3

Monitoring and Surveillance

• Regular monitoring of albuminuria and eGFR is necessary to evaluate the effectiveness of treatment 4
• The American Journal of Kidney Diseases recommends surveillance of serum potassium and creatinine levels, particularly when combining dapagliflozin with an ACEi or ARB 4