SGLT2 Inhibitors in Non-Diabetic CKD: Effects on Vascular Calcification and Anemia

Chronic kidney disease (CKD) is a serious health problem that affects millions of people worldwide. It often leads to worsening kidney function, anemia (low blood count), and heart problems. While diabetes is a common cause of CKD, many patients develop kidney disease without having diabetes. These patients still face high risks of anemia and cardiovascular complications, but treatment options remain limited.

Dapagliflozin, a medicine from the sodium-glucose co-transporter 2 (SGLT2) inhibitor family, was originally developed to lower blood sugar in people with diabetes. However, recent large studies have shown that dapagliflozin can also protect the kidneys and improve heart health-even in patients who do not have diabetes. There is also evidence that this drug may help improve anemia by boosting the body's ability to make red blood cells.

This study is designed to test whether dapagliflozin can provide these benefits in adults with CKD who do not have diabetes. The trial will compare dapagliflozin to a placebo (a pill with no active drug) alongside standard medical care.

Key goals of the study are to learn:

Whether dapagliflozin slows the decline of kidney function.

Whether it improves anemia by increasing hemoglobin and related blood markers.

Whether it improves heart health, including heart function and blood vessel changes.

How safe dapagliflozin is for patients with CKD who do not have diabetes.

How the study works:

About 100 adults with CKD will take part.

Participants will be randomly assigned to receive either dapagliflozin or a placebo, in addition to their usual medications.

The treatment will last for 12 months.

Participants will visit the clinic every 3 months for checkups, blood and urine tests, and heart evaluations such as echocardiography and ECG.

At the end of the study, researchers will compare kidney function, anemia markers, and heart health between the two groups.

Why this study matters: If dapagliflozin proves effective, it could become an important new option for patients with CKD who do not have diabetes. This would mean better kidney outcomes, fewer complications from anemia, and improved heart health for a large group of patients who currently have limited treatment choices.

Inclusion criteria

• Adults aged ≥18 years with a diagnosis of chronic kidney disease (CKD), non-diabetic etiology.
• Estimated glomerular filtration rate (eGFR) between 20 and 60 mL/min/1.73 m² at screening.
• Stable standard CKD care for at least 3 months prior to enrollment.
• Ability to provide written informed consent.

Exclusion criteria

• Diagnosis of diabetes mellitus (type 1 or type 2).
• History of kidney transplantation or currently on dialysis.
• Acute kidney injury within the past 3 months.
• Known hypersensitivity to dapagliflozin or excipients.
• Pregnant or breastfeeding women.
• Participation in another interventional clinical trial within the past 30 days.
• Severe uncontrolled cardiovascular disease (e.g., recent myocardial infarction, unstable angina, decompensated heart failure).
• Any condition judged by the investigator to interfere with study participation or interpretation of results.