The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management glomerular/systemic autoimmune diseases with proteinuria in real-world clinical settings is unclear. Retrospective, observational, international cohort study. Adult patients with biopsy-proven glomerular diseases were included. The main outcome was the percentage reduction in 24-hour proteinuria from SGLT2i initiation to 3,6,9,12 months. Secondary outcomes included percentage change in estimated glomerular filtration rate(eGFR), proteinuria reduction by type of disease, and reduction of proteinuria ≥ 30% from SGLT2i initiation. Four-hundred and ninety-three patients with a median age of 55 years and background therapy with renin-angiotensin system blockers were included. Proteinuria from baseline changed by –35%, –41%, –45% and –48% at 3, 6, 9 and 12 months after SGLT2i initiation, while eGFR changed by –6%, –3%, –8%, –10.5% at 3,6,9 and 12 months, respectively. Results were similar irrespective of the underlying disease. A correlation was found between body mass index (BMI) and percentage proteinuria reduction at last follow-up. By mixed-effects logistic regression model, serum albumin at SGLT2i initiation emerged as predictor of ≥ 30% proteinuria reduction (odds ratio for albumin < 3.5 g/dl: 0.53; 95%CI 0.30–0.91; p = 0.02). A slower eGFR decline was observed in patients achieving a ≥ 30% proteinuria reduction: –3.7 versus –5.3 ml/min/1.73m²/year (p = 0.001). The overall tolerance to SGLT2i was good. The use of SGLT2i was associated with a significant reduction of proteinuria. This percentage change is greater in patients with higher BMI. Higher serum albumin at SGLT2i onset is associated with higher probability of achieving a ≥ 30% proteinuria reduction.

The effect of a third vaccine dose (3D) of homologous mRNA vaccine on blood levels of SARS-CoV-2-receptor binding domain (RBD)-total antibodies was assessed in 40 hemodialysis patients (HD) and 21 kidney transplant recipients (KTR) at a median of 46 days after 3D. Anti-RBD antibodies were detected in 39/40 HD and 19/21 KTR. Overall, 3D boosted anti-RBD antibody levels (median: 58-fold increase). Neutralizing antibodies (NtAb) against the Wuhan-Hu-1, Delta, and Omicron variants were detected in 14, 13, and 11 out of 14 HD patients, and in 5, 5, and 4 out of 8 KTR patients, respectively. The median fold increase in NtAb titers in HD patients was 77, 28, and 5 and 56, 37, and 9 in KTR patients for each respective variant. SARS-CoV-2-S S-IFN-γ-producing CD8⁺ and CD4⁺ T-cell responses were detected in the majority of HD (35 and 36/37, respectively) and all KTR (16/16) patients at 3D. Overall, the administration of 3D boosted T-cell levels in both population groups. In conclusion, a homologous mRNA COVID-19 vaccine 3D exerts a booster effect on anti-RBD antibodies, NtAb binding to Wuhan-Hu-1, Delta, and Omicron variants, and SARS-CoV-2-S-IFN-γ-producing T cells in both HD and KTR patients. The magnitude of the effect was more marked in HD than KTR patients.

Lupus nephritis is a major cause of morbidity in patients with systemic lupus erythematosus. Responsiveness to treatment is crucial to avoid chronic kidney disease. New molecules have been developed in recent years to improve renal survival rates. Biological therapies as coadjutant to conventional induction treatment have been tested in randomized clinical trials with heterogeneous results. Like many others biologic therapies, Abatacept has not shown a clear benefit in the context of clinical trials. We present two cases of lupus nephritis patients in whom addition of abatacept resulted in complete remission of the renal disease. The first case described a 49-year-old male with class IV lupus nephritis with nephrotic range proteinuria and high immunological activity refractory to conventional treatment with cyclophosphamide and corticosteroids and multitarget therapy with tacrolimus, mycophenolate mofetil and prednisone. Several biological therapies (rituximab, belimumab and tocilizumab) were unsuccessfully tried, so that abatacept was added to his background multitarget therapy showing complete clinical response. The second case described a 52-year-old female with class IV lupus nephritis treated initially with conventional treatment with partial response. In successive renal flares with nephrotic proteinuria, she showed intolerance to rituximab and refractoriness to voclosporin. Finally, abatacept was added to her background therapy with MMF and PDN showing complete and maintained remission of the disease. In no case the use of abatacept was associated with serious adverse events. Based on our experience, abatacept should be considered as a safe rescue therapy in patients with refractory lupus nephritis and proteinuria with nephrotic range. In addition to this case, we reviewed the use of abatacept in lupus nephritis in the literature.

Chronic kidney disease (CKD) is a prevalent condition that requires reliable tools to predict its progression to end-stage renal disease (ESRD). The KFRE equation, internationally validated, allows for estimating the risk of progression at 2 and 5 years. However, it has not been validated in the Spanish population. This study aims to evaluate the predictive capacity of the KFRE in a cohort of Spanish patients. This is a multicenter, observational, and retrospective study conducted in patients with an estimated glomerular filtration rate (eGFR)<30ml/min who were followed in nephrology clinics between January 2016 and 2021. A total of 602 patients with clinical and demographic data were included. The predictive capacity of the KFRE, in its 4-variable and 8-variable versions, was evaluated using Cox regression analysis and ROC curves. Of the 602 patients included, 60% were male. Diabetes was the main etiology. Among the patients who started renal replacement therapy (RRT), 37% did so within two years, and 70% began with hemodialysis. Patients who initiated RRT (50.6%) were younger, had a lower eGFR, and exhibited higher baseline albuminuria. The 4-variable KFRE equation showed an AUC of 0.7639 (95% CI: 0.71-0.81) and demonstrated superior accuracy compared to the 8-variable model. The KFRE equation, particularly in its 4-variable version, proves to be useful in predicting the progression to ESRD in the Spanish population. However, recalibration is necessary to improve its accuracy in this context.

Background: Peritoneal dialysis (PD) has emerged as an effective technique for managing refractory heart failure (HF) in patients unresponsive to diuretics. Previous meta-analyses have demonstrated significant reductions in hospitalization days and improvements in cardiac function among patients with HF treated with PD compared with those receiving standard therapies. However, sodium retention remains a challenge in HF management, as patients often exhibit poor compliance with dietary sodium restrictions. In patients on PD, sodium retention exacerbates fluid overload and cardiovascular complications, highlighting the need for effective sodium elimination strategies. Methods: This study will investigate the effects of PD on sodium excretion and its impact on mortality and heart failure exacerbations. We will enroll 31 patients with refractory HF in a continuous ambulatory peritoneal dialysis program. The study design includes randomization, a washout period, and an open-label approach to evaluate the impact of dapagliflozin, a sodium-glucose cotransporter-2(SGLT2) inhibitor, on sodium balance and clinical outcomes. Statistical analysis will be performed to assess changes in sodium excretion and the association between sodium removal levels and clinical outcomes. Expected results: We hypothesize that dapagliflozin in patients undergoing PD will enhance net sodium loss by combining its known natriuretic efficacy with the hypothesis of increased sodium elimination in the peritoneal effluent. This effect is expected to be observed independently of the patients’ baseline renal function. Additionally, the study will investigate the safety profile of dapagliflozin in PD patients, monitoring for potential adverse effects and overall tolerability. Conclusions: The study aims to provide valuable insights into optimizing HF management in PD patients through innovative therapeutic approaches. The anticipated findings could significantly impact clinical practice by improving sodium and fluid balance, potentially leading to reduced hospitalizations and better overall health outcomes for HF patients on PD. Trial Registration: This study was approved and authorized by both the Spanish Agency of Drugs and Health Products (AEMPS) and the Hospital Clínico Universitario de Valencia Ethical Committee (CEIM). The investigated drug, dapagliflozin, has received approval from the European Medicines Agency (EMA) and has been authorized for commercialization in Spain (CEIM FILE: 148/23, CODE: DAPA-DP, EUDRACT no.: 2023-505571-78-00).