Dapagliflozin

Dapagliflozin belongs to the SGLT2 inhibitor drug class, which is recognised for cardioprotective and nephroprotective effects in chronic conditions. A prior paediatric pilot study found reduced 24-hour urinary protein after adding dapagliflozin to RAAS inhibitor therapy while eGFR stayed stable at 24 weeks. Children weighing 30 kg or less receive 5 mg dapagliflozin once daily throughout treatment periods. Children weighing more than 30 kg start dapagliflozin at 5 mg once daily and increase to 10 mg once daily after the first week. The 10 mg dapagliflozin dose is based on recommended chronic-use dosing for approved indications. The trial’s central hypothesis is that dapagliflozin may improve long-term outcomes by preventing progression of cardiovascular and renal injury or mitigating cardiovascular consequences of critical illness. Dapagliflozin may be reduced or withheld if volume depletion, hypotension, or renal dysfunction persists after adjusting other non-essential medications. Dapagliflozin is being tested as an add-on to existing RAAS inhibitor therapy in children with hereditary kidney disease and proteinuria.