Lupus Nephritis (LN), Chronic Kidney Disease, SGLT 2 Inhibitors, Systemic Lupus Erythematosus
Conditions
Keywords
lupus nephritis, SGLT2 inhibitors
Brief summary
Lupus nephritis is one of the most serious complications of lupus, an autoimmune disease in which the immune system mistakenly attacks the body's own tissues. This condition causes inflammation and damage to the kidneys and is a major cause of chronic kidney disease, especially in the Latin American population. In these patients, the disease often appears at a younger age, presents with more intense inflammation, and has a more aggressive course. Although treatments exist that help control the immune response and reduce kidney damage, a significant proportion of patients do not achieve sustained kidney recovery. As a result, protein loss in the urine persists, and kidney function continues to deteriorate over time. Given this situation, new therapeutic alternatives have emerged aimed at protecting kidney function. Among them is dapagliflozin, a medication that has shown benefits in various types of chronic kidney disease by helping to lower pressure within the kidneys, reduce inflammation, and limit the formation of scar tissue. However, there is still limited information on its effectiveness in people with active lupus nephritis. The objective of this study is to evaluate the efficacy and safety of dapagliflozin in preventing the progression of chronic kidney disease in patients with lupus nephritis. The results will generate scientific evidence to help improve renal protection strategies in this population. To this end, a phase II, open-label, controlled, randomized clinical trial will be conducted in adult patients newly diagnosed with lupus nephritis treated at the Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Participants will be randomly assigned in a one-to-one ratio to two groups: one will receive standard treatment plus dapagliflozin (10 mg daily), and the other will receive only standard treatment. For three months, the amount of protein excreted in urine, renal function, and progression to chronic kidney disease will be evaluated. In addition, potential adverse effects, changes in lupus activity, and variables related to the prevention of cardiovascular, renal, and metabolic diseases will be recorded.
Detailed description
\*\*Description of Procedures\*\* Participants who meet the inclusion and exclusion criteria and provide written informed consent will be randomly assigned in a 1:1 ratio to one of two study groups: standard treatment plus dapagliflozin 10 mg/day or standard treatment alone. Participants in the intervention group will receive a three-month supply of dapagliflozin (84 tablets). All participants will continue routine outpatient follow-up for a period of three months. The primary evaluation will include baseline and 3-month measurements of proteinuria (using either the urine protein-to-creatinine ratio in a spot urine sample or 24-hour urine protein quantification) and kidney function assessed by estimated glomerular filtration rate (eGFR). These laboratory tests are part of the standard clinical monitoring of patients with lupus nephritis. Renal response will be classified according to the KDIGO 2024 recommendations as complete remission, primary renal response, partial response, or no response, based on changes in proteinuria and kidney function during follow-up. Additionally, cardiovascular-kidney-metabolic health status will be assessed at baseline and at the end of the study using the 2023 American Heart Association classification, to determine improvement, stability, or progression of cardiovascular, renal, and metabolic risk. The use of other antiproteinuric medications will be allowed at the discretion of the treating physician, except for SGLT2 inhibitors in the control group. Adverse events and safety outcomes will be monitored throughout the study. If adverse effects or contraindications related to dapagliflozin occur, the medication will be discontinued and appropriate medical care will be provided.
Interventions
Participants in the experimental group will receive a 3-month supply of dapagliflozin 10 mg/day. During follow-up, baseline measurements of lupus nephritis activity, proteinuria, eGFR, and safety will be assessed at baseline, 1 month, and 3 months.
DEVICEProteinuria Quantification
Estimación de los niveles de proteinuria por el índice proteínas/creatinina en muestra única de orina o la cuantificación de proteínas en muestra de orina de 24 horas según corresponda, así como la tasa de filtrado glomerular estimada.
Sponsors
Hospital Civil Juan I. Menchaca
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants in the intervention group will receive dapagliflozin 10 mg/day for three months (84 tablets). In both groups, proteinuria will be assessed at baseline and after three months using either the urine protein-to-creatinine ratio or 24-hour urine protein quantification, along with estimated glomerular filtration rate (eGFR). These laboratory tests are part of the routine follow-up of patients with lupus nephritis. The day of enrollment will be considered day 0 for evaluating progression to chronic kidney disease during the follow-up period. The use of other anti-proteinuric medications will be allowed in both groups and will not be considered an exclusion criterion; however, the use of SGLT2 inhibitors will be discouraged in the control group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients over 18 years of age. 2. Patients who agree to participate in the study after signing an informed consent form. 3. Patients who meet the classification criteria for systemic lupus erythematosus proposed by the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) 2019. 4. Patients diagnosed with active lupus nephritis based on one or a combination of the following: \- Renal biopsy: based on a report of the following histological classes: I, II, III, IV, V, or mixed (combinations of the aforementioned classes), following the recommendations of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis and modified National Institutes of Health (ISN/RPS) 2018 (Appendix 1). -Clinical: diagnostic variables of renal domain activity according to the SELENA-SLEDAI or Mex-SLEDAI composite clinical criteria (Appendix 2), with proteinuria always estimated on more than two occasions. 5. Patients with proteinuria greater than 500 mg/dL per day, quantified by the protein/creatinine ratio in a single urine sample or by quantification of protein in a 24-hour urine collection.
Exclusion criteria
* 1\. Pacientes con diagnóstico por biopsia o a integración del clínico de nefritis lúpica con temporalidad mayor a 6 meses. 2\. Pacientes bajo tratamiento actual con algún inhibidor iSGLT2, sulfonilureas, bombas de infusión continua de insulina. 3\. Pacientes con contraindicación del uso de inhibidor SGLT2. (Estadio clínico de enfermedad renal crónica KDIGO IV o tasa de filtrado glomerular estimada \<20 ml/min, estado de deshidratación moderado a severo, sospecha de infección grave aguda, requerimiento de evento quirúrgico en días próximos. Infecciones del tracto urinario o genitales severas, recurrentes (\>3 eventos/año), o con uso de dispositivos urinarios permanentes. 4\. Pacientes en embarazo en curso, puerperio o lactancia. 5. Paciente con requerimiento de reanimación hídrica agresiva, uso de aminas vasoactivas, requerimiento de dispositivos de ventilación mecánica invasiva o de alto flujo, terapias de sustitución orgánica, falla orgánica múltiple, infección grave o complicada, o cualquier estado patológico que por criterio clínico se considere al paciente como crítico. 6\. Estado de acidosis metabólica (por gasometría venosa pH \<7.30) o sospecha de cetoacidosis euglucémica. 7\. Pacientes con diagnóstico previo de Diabetes Mellitus tipo 1, tipo 2 o con el reporte al tamizaje de HbA1c \> 6.5%, glucemia en ayuno ≥126 mg/dL o glucemia ≥200 mg/dL asociado a síntomas de hiperglucemia. 8\. TFGe \<20 mL/min o requerimiento de terapia de sustitución renal previa o inminente.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Definition of renal remission in lupus nephritis proposed by the KDIGO 2024 guideline (Kidney Disease: Improving Global Outcomes, Clinical practice guideline for the management of lupus nephritis). | The monitoring of our overall objective will be evaluated one month and three months after the start of enlistment. | The following variables and definitions of remission in lupus nephritis will be reported: * Complete: Reduction of proteinuria to \<500 mg/dL. Stabilization or improvement of the estimated glomerular filtration rate (eGFR) (10-15% of baseline). * Primary renal response: Proteinuria \<700 mg/dL. No worsening of the eGFR \>20% of baseline or greater than 60 mL/min/1.73 m². No use of rescue therapy. * Partial: Reduction of proteinuria by at least 50% to \<3,000 g/dL and stabilization or improvement of the eGFR (10-15% of baseline). * No renal response: Failure to achieve any of the above definitions within 3 months. |
Countries
Mexico
Contacts
STUDY_DIRECTORMónica Vázquez-Del Mercado Espinosa, MD, PhD.
Hospital Civil Juan I. Menchaca
Outcome results
None listed