Dapagliflozin in Non-diabetic Stage IV CKD

Prior treatment

• Participation in another clinical study with an investigational product during the last month
• Concomitant treatment with steroids or any other immunosuppressive agent
• Drug or alcohol abuse
• Participation in another interventional clinical trial within the 4 weeks prior to screening.

Other illness

• Active systemic autoimmune diseases;
• Hypersensitivity to the active principle (dapagliflozin) or any of the excipients (e.g. lactose);
• Severe/unstable heart failure with or without decreased systolic function requiring hospitalization or changes in pharmacological therapy over the last three months
• Uncontrolled hypertension (BP \>150/90 mmHg despite optimized pharmacological treatment and diet or symptomatic hypotension
• Positive hepatitis C antibody hepatitis B virus surface antigen or hepatitis B virus core antibody, at screening

Lab values

• Ischemic kidney disease (because of possible excess risk of acute kidney injury upon SGLT2-inhibitor associated reduction in sodium pool and kidney perfusion pressure)
• Rapidly progressive kidney disease (e GFR reduction ≥ 30% over the last three months) and expected risk of progression to end stage kidney failure and need of renal replacement therapy by dialysis or transplantation during the study period.

Other

• Involvement in the planning and/or conduct of the study (applies to both Investigator staff and/or staff at the study site)
• Known to have tested positive for human immunodeficiency virus
• Inability to fully understand the possible risks and benefits related to study participation
• If female, the subject is pregnant or lactating or intending to become pregnant before, during, or within 90 days after last dose; or intending to donate ova during such time period;
• If male, the subject intends to donate sperm while on the study this study or for 90 days after last dose;

• Provision of informed consent prior to any study specific procedures
• Male or female more than 18 year old
• Non-diabetic Stage-IV CKD
• Fasting blood glucose ≤ 125 mg (≤ 6.9 mmol/l) and HbA1C ≤6.4% (≤ 47 mmol/mol)58 without treatment with oral blood glucose lowering medications and/or insulin
• Two-hour plasma glucose \<200 mg/dl during 75-g oral glucose tolerance test (OGTT)58
• Persistent proteinuria (24-hour urinary protein excretion ≥ 0.5 grams in at least two consecutive evaluations \>1 week apart) despite RAS inhibitor therapy with ACE inhibitors and/or ARBs (or without RAS inhibitors in patients with specific contraindications to these medications)
• eGFR 15 to 30 ml/min/1.73 m2 by CKD-Epi equation
• Blood pressure \<150/90 mmHg without changes in blood pressure lowering medications over the last four weeks before the randomization
• Negative pregnancy test (urine or serum) for female subjects of childbearing potential.10
• Female subjects must be 1 year post-menopausal, surgically sterile, or using an acceptable method of contraception (an acceptable method of contraception is defined as a barrier method in conjunction with a spermicide) for the duration of the study (from the time they sign consent) and for 3 months after the last dose of dapagliflozin\\placebo to prevent pregnancy. In addition, oral contraceptives, approved contraceptive implant, long-term injectable contraception, intrauterine device, or tubal ligation are allowed. Oral contraception alone is not acceptable; additional barrier methods in conjunction with spermicide must be used.
• Male subjects must be surgically sterile or using an acceptable method of contraception (defined as barrier methods in conjunction with spermicides) for the duration of the study (from the time they sign consent) and for 3 months after the last dose of IMP to prevent pregnancy in a partner.
• Subjects who are blood donors should not donate blood during the study and for 3 months following their last dose of dapagliflozin\\placebo.