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Is reduction in proteinuria with SGLT2i dose dependent?

2 Answers
Mednet MemberInvited Expert
Nephrology · University Of California San Diego Medical Center Hillcrest
Answered on

My understanding of dosing with empagliflozin, in particular, is that it is not dose-dependent, thus a dose of 10 mg versus 25 mg will lead to a similar reduction in proteinuria. This is based on data from the EMPA REG OUTCOME trial published in NEJM in 2016. The composite outcome of incident or worsening nephropathy was significantly lower in the empagliflozin group than placebo, and there was no difference seen in the two doses of empagliflozin. As a result, I have extrapolated to consider the reduction in proteinuria equal between the two doses.

For dapagliflozin, the other SGLT2i that I use with frequency, there is no data published on dosing below 10 mg daily. As a result, with this SGLT2i I do target the higher dose of 10 mg daily if ...

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Mednet MemberInvited Expert
Nephrology · University Of California San Francisco Medical Center At Parnassus
Answered on

I far as I am aware this has not been studied yet. My belief is that if the amount of glucosuria and sodium excretion increases with higher doses, then higher doses would be more effective. It is also possible that even the lower doses already cause maximum inhibition of SGLT-2 and further increases in the dose would not result in more glucosuria.

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