Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors attenuate incident cardiovascular outcomes, irrespective of baseline GFR, in conservatively managed CKD. As this condition inexorably progresses to demanding KRT, drug withdrawal is supported by the current lack of evidence of safety of SGLT2 inhibitors in dialysis. Methods: This study was a prospective, single-center, open-label trial (ClinicalTrials.gov identifier: NCT05343078) aimed at assessing the pharmacokinetic properties and safety of dapagliflozin in patients with kidney failure on regular dialysis regimens compared with those with type 2 diabetes and age- and sex-matched controls with normal kidney function. Peripheral blood samples were collected from both groups every 30 minutes for 4 hours and again after 48 hours after ingestion of dapagliflozin 10 mg, which occurred immediately before dialysis session initiation in the kidney failure group. This protocol occurred in drug-naïve patients and again after six daily doses of dapagliflozin to assess whether the drug had accumulated. The plasma and dialysate levels of dapagliflozin at each time point were determined by liquid chromatography and used to calculate pharmacokinetics parameters (peak concentration [C_max] and area under the plasma concentration-versus-time curve) for each participant. Results: Dapagliflozin C_max was 117 and 97.6 ng/ml in the kidney failure and control groups, respectively, whereas the corresponding accumulation ratios were 26.7% and 9.5%. No serious adverse events were reported for either group. Dapagliflozin recovered from dialysate corresponded to 0.10% of the administered dose. Conclusions: In patients with kidney failure on dialysis, dapagliflozin was well tolerated, was slightly dialyzable, and had nonaccumulating pharmacokinetic properties. Clinical Trial registry name and registration number: Pharmacokinetics and Dialyzability of Dapagliflozin in Dialysis Patients (DARE-ESKD 1), NCT05343078

The increase in the number of users, hospitalizations and deaths due to overdose of synthetic opioids made the scientific community to treat this problem as “the opioid crisis”, justifying the need for the development of analytical strategies to identify and quantify these drugs. Even with the global discussion, there is no Brazilian data regarding opioids consumption, addiction or fatal intoxication cases. The aim of this work was to develop, validate and applied an analytical method based on liquid chromatography-tandem mass spectrometry for determination of fentanyl and seven analogues (acetyl norfentanyl, acetyl fentanyl, thiofentanyl, acrylfentanyl, furanylfentanyl, carfentanil and valerylfentanyl) in postmortem blood samples, to the routine analysis of the Forensic Toxicology Laboratory of São Paulo State Police. Linearity was evaluated from 1-500 ng mL-1 (correlation coefficient (r) value (r ≥ 0.99), 1/x weight linear regression), with limit of quantification of 1 ng mL-1. The method imprecision, bias and matrix effect were lower than 19.7%. No interference or carryover were observed, and extraction yield was greater than 57.7%. Analysis of postmortem blood samples (n = 1,359) showed that fentanyl was the most frequently detected opioid. The developed method proved to be useful for routine analysis of the Forensic Toxicology Laboratory.