Role of Dapagliflozin versus Empagliflozin as add-on Therapy on Diabetic Nephropathy

Background: Diabetic nephropathy affect approximately 50% of type 2 diabetics. Early detection of kidney disease is crucial to reduce deterioration of renal function, beside reversing microalbuminuria showed beneficial effects in delaying the onset or even reversing the progression of the disease. Recently, sodium/glucose cotransporter-2 inhibitors have received attention for their anti-inflammatory and reno-cardioprotective effects. Aim: This interventional study aimed to evaluate and compare the clinical outcomes of two sodium/glucose cotransporter-2 inhibitors, Dapagliflozin vs. Empagliflozin, as add-on therapy on renal function parameters and other injury markers. Methodology: Forty-one of type 2 diabetic nephropathy patients had been divided into two groups randomly. The first group treated with Dapagliflozin 5mg/day and the second group treated with Empagliflozin 10 mg/day, for 16 weeks as add-on. Blood and urine samples were collected at baseline and at week 16 to evaluate the glycemic, weight parameters, renal function (urinary albumin/creatinine ratio, serum urea and creatinine, estimated glomerular filtration rate, and lipid profile. Results: After 16 weeks, Dapagliflozin and Empagliflozin significantly reduced HbA1c, body mass index, waist circumference (p<0.01). Albuminuria reduced significantly with Empagliflozin and Dapagliflozin (p<0.05). A mild elevation in serum creatinine was observed with significant difference between two medications. Empagliflozin showed a mild reduction in glomerular filtration rate compared with Dapagliflozin. Empagliflozin significantly reduced cholesterol while Dapagliflozin significantly reduced LDL-c, TG and VLDL levels (p<0.05). No change in HDL-c level in both groups. Conclusion: Adding Dapagliflozin or Empagliflozin effectively improved albuminuria, glycemic status and weight parameters. The preference was for Dapagliflozin regarding renal function and lipids.