Is There a Future for SGLT2 Therapy to Treat Kidney Failure in US Veterans Living with Autosomal Dominant Polycystic Kidney Disease?

I was always told Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a disease of “old age.” Medical professionals told me this at my diagnosis, and in my eyes, my paternal grandmother was living proof. For as long as I can remember, my paternal grandmother was sick. It was not until she received a kidney transplant that I fully understood what part of her body was affected by her “sickness.” While my grandmother was recovering from her transplant surgery, my parents decided to have me screened for ADPKD. My father was already aware that he had inherited ADPKD from his mother. Thus, the elephant in the room for my parents was knowing whether their children had the same disease. Being the youngest, I was screened first at the age of 12 by ultrasound. The ultrasound confirmed my parent's fears while solidifying my future as a kidney failure patient. My ADPKD diagnosis and lived experience has allowed me to find my voice in the world of kidney health. The kidney failure journey pressed upon my life has afforded me the opportunity to give patient commentary to the referenced article “Association of sodium-glucose cotransporter 2 inhibitors (SGLT2i) therapy with longitudinal eGFR changes among US Veterans with ADPKD.” This retrospective study contains data on military veterans with ADPKD being administered inhibitor medications SGLT2i/dipeptidyl peptidase-4 inhibitors (DPP4i). These inhibitors have confirmed their place in the kidney disease community to harness treating patients. SGLT2i and DPP4i are more than just inhibitors for treating diabetic patients, specifically type 2 diabetes. They are responsible for weight loss, ketogenesis, increased tubulo-glomerular feedback, and improved glycemic control. The study participants in this article were characterized by age, sex, race, ethnicity, eGFR, albumin, hemoglobin, and other comorbidities such as heart failure or ischemic stroke just to name a few. This study was an area of focus for patients with ADPKD specifically to determine if inhibitors such as SGLT2i and DPP4i would slow the decline of kidney function.1 An interesting key point in this article is that SGLT2i in previous controlled trials revealed the slowing of kidney disease progression in participants with and without diabetes. After reading this article and studying the given table and figures, a few things stood out to me. The population of this study was predominantly male—93% to be exact. All participants were 60 years of age or older, and comorbidities such as hypertension and type 2 diabetes were present in a great percentage of participants. I would have liked it if this study comparatively had a higher population of women and a younger targeted audience in both men and women. The reasoning behind my statement is because I have encountered just as many women with ADPKD as men. In addition, with a younger target audience for the study, we could potentially assess the eGFR changes prior to the “old age” reference of ADPKD. I am living proof that ADPKD can become aggressive younger than 60 years especially with the presence of other comorbidities. I am not diabetic, but I do have a comorbidity of hypertension. I was diagnosed with hypertension at 17 years old while pregnant with my first child. Even after safely birthing my son, I was advised that my high BP would need to be managed for the rest of my life with medication. As life would have it, my failure to adhere and comply with my doctor's order to take my BP medicine as prescribed moved my GFR to dangerous lows very quickly. The direct mention of participants and their ability to adhere to the given inhibitors in this study were noted and appreciated for the reference of adherence brings truth to the forefront in studies like these. The conclusion of the retrospective study presented in this article was thoroughly researched, and I feel it was honestly conveyed by the authors of this article. My earlier mention of the mostly male and older population was referenced as limitations for the study by authors. The possibility of benefit for older patients with ADPKD taking a SGLT2i with comorbidities and slowing kidney progression from this study shows signs of promise pending further required studies. The transparency given by the authors along with the data provided by multiple VA Healthcare Systems gives a hopeful and inspiring future for patients with ADPKD. My experience within the local nephrology community reflects an absence of priority for ADPKD, yet the beauty of this article suggests that ADPKD is no longer an afterthought but a focus.