End-stage Renal Disease
Conditions
Keywords
hemodialysis, dapagliflozin, peritoneal dialysis
Brief summary
Sodium-glucose co-transporter 2 inhibitors (Sglt2i) attenuate the incidence of cardiovascular events in individuals with preserved or mildly reduced kidney function. Whether this benefit is also observed among individuals with end-stage renal disease (ESRD), in whom cardiovascular disease is a leading cause of mortality, remains unexplored. To appraise the influence of dialysis on the pharmacokinetics of Sglt2i is a prerequisite to determining the treatment regimen that best fits this population. In this study ESRD individuals, aged 18 years and older, on a regular dialysis regimen for a minimum of 3 months at the Nephrology Division of the Clinics Hospital of the University of Campinas (Unicamp) will be enrolled in a pharmacokinetics study. In the single-dose protocol, hemodialysis participants will take Dapagliflozin 10mg P.O. immediately before the dialysis session, and blood samples will be collected every 30min during dialysis and again 24h and 48h after termination. The dialysate will be continuously sampled in a tank and aliquots collected for further analysis. In the multiple-dose protocol, both hemodialysis and peritoneal dialysis participants will take Dapagliflozin 10mg P.O. daily in the morning for 7 days. Blood samples will be collected at baseline, and again after 48h and 7 days. The plasma levels of dapagliflozin and its inactive metabolite, D3OG, will be calculated from blood and dialysate samples using liquid chromatography mass spectrometry. The primary outcome is the plasma concentration-time curve of dapagliflozin and its inactive metabolite D3OG during a regular hemodialysis session. Secondary outcomes are: (i) the steady-state plasma concentration of Dapa; (ii) the accumulation ratio of Dapa; (iii) the total mass of Dapa and D3OG extracted by the dialysate; (iv) the dialytic clearance of dapagliflozin.
Interventions
DRUGDapagliflozin 10Mg Tab
Participants will take a single-dose Dapagliflozin 10mg P.O. prior to the hemodialysis session for the single-dose pharmacokinetics protocol. In the multiple-dose protocol, Dapagliflozin 10mg P.O. will be taken daily in the morning for one week.
Sponsors
University of Campinas, Brazil
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
In the single-dose protocol, hemodialysis participants will take the experimental drug immediately prior to the dialysis session. In the multiple-dose protocol, volunteers will take the drug daily in the morning for one week.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Dialysis for 3 months or more prior to enrollment * 18 years of age or older * Signed the informed consent form
Exclusion criteria
* Liver dysfunction * Allergy to dapagliflozin * Currently receiving a Sglt2i
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Area under the curve of the plasma concentration-time curve of dapagliflozin | From dialysis initiation to 48 hours post- drug administration | AUC of dapagliflozin (ng.mL / mL) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Area under the curve of the plasma concentration-time curve of D3OG | From dialysis initiation to 48 hours post- drug administration | AUC of D3OG (ng.mL / mL) |
| Steady-state plasma concentration of Dapagliflozin | 7 days | Steady-state plasma concentration (ng/mL) |
| Steady-state accumulation ratio of Dapagliflozin | 7 days | Accumulation index |
| Total mass of dapagliflozin extracted by the dialysis | 7 days | Dapagliflozin mass (mg) |
Countries
Brazil
Outcome results
None listed