{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:58:30Z","timestamp":1790657910282,"version":"4.1.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nephrol."],"abstract":"<jats:p>\n                    Sodium\u2013glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits in chronic kidney disease, yet their role in peritoneal dialysis (PD) remains largely unexplored, and clinical experience is limited. We describe, at the individual-patient level, seven consecutive patients treated with an SGLT2i at a single centre (median age 69 years, range 43\u201373; five men; one with type 2 diabetes; six dapagliflozin, one empagliflozin). The PD prescription was not modified during treatment, and ultrafiltration refers to the 24-hour drained volume. In the four patients in whom the drug was added to established, unchanged PD, ultrafiltration rose in three and fell in one; the single non-responder was also the only low-average transporter and was later transferred to haemodiafiltration. Both patients anuric at baseline increased their ultrafiltration, and in one of them PD was the only feasible modality. Peritoneal transport category was unchanged wherever paired equilibration tests were available. Serum urate fell in the patients with preserved diuresis but not in those who were anuric, whereas the largest ultrafiltration gain occurred in a patient anuric throughout, dissociating the peritoneal response from any renal effect. The erythropoietin resistance index fell in all treated patients, although the magnitude was clinically relevant in a minority and must be read alongside the haemoglobin trajectory. No patient developed anuria\n                    <jats:italic>de novo<\/jats:italic>\n                    . One patient died of fungal peritonitis in the context of documented non-adherence, an event reported here with its mechanistic implications. These observations support a direct peritoneal mode of action and warrant prospective evaluation with surveillance for fungal infection.\n                  <\/jats:p>","DOI":"10.3389\/fneph.2026.1942462","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:33:46Z","timestamp":1790656426000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["SGLT2 inhibitors as a strategy for volume management in peritoneal dialysis: a case series"],"prefix":"10.3389","volume":"6","author":[{"given":"R. Haridian","family":"Sosa Barrios","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hospital Universitario Ram\u00f3n y Cajal","place":["Madrid, Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Madrid, Spain"]},{"name":"Universidad de Alcal\u00e1 (UAH)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Dom\u00ednguez-Tejedor","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario Ram\u00f3n y Cajal","place":["Madrid, Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Moreno Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario Ram\u00f3n y Cajal","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edctor M.","family":"Burguera Vion","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario Ram\u00f3n y Cajal","place":["Madrid, Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagros","family":"Fern\u00e1ndez Lucas","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario Ram\u00f3n y Cajal","place":["Madrid, Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Madrid, Spain"]},{"name":"Universidad de Alcal\u00e1 (UAH)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maite E.","family":"Rivera Gorr\u00edn","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario Ram\u00f3n y Cajal","place":["Madrid, Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Madrid, Spain"]},{"name":"Universidad de Alcal\u00e1 (UAH)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2001.060002767.x","article-title":"Effect of fluid and sodium removal on mortality in peritoneal dialysis patients","volume":"60","author":"Ate\u015f","year":"2001","journal-title":"Kidney Int"},{"key":"B2","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.semnephrol.2016.10.006","article-title":"Fluid overload in peritoneal dialysis patients","volume":"37","author":"Kim","year":"2017","journal-title":"Semin Nephrol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2021010080","article-title":"Acquired decline in ultrafiltration in peritoneal dialysis: The role of glucose","volume":"32","author":"Krediet","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-018-4656-5","article-title":"Physiology of renal glucose handling via SGLT1, SGLT2 and GLUT2","volume":"61","author":"Ghezzi","year":"2018","journal-title":"Diabetologia"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816","article-title":"Dapagliflozin in patients with chronic kidney disease","volume":"383","author":"Heerspink","year":"2020","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204233","article-title":"Empagliflozin in patients with chronic kidney disease","volume":"388","author":"Herrington","year":"2023","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1811744","article-title":"Canagliflozin and renal outcomes in type 2 diabetes and nephropathy","volume":"380","author":"Perkovic","year":"2019","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1159\/000531084","article-title":"Mechanistic and clinical comparison of the erythropoietic effects of SGLT2 inhibitors and prolyl hydroxylase inhibitors in patients with chronic kidney disease and renal anemia","volume":"55","author":"Packer","year":"2024","journal-title":"Am J Nephrol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1159\/000520894","article-title":"Peritoneal expression of SGLT-2, GLUT1, and GLUT3 in peritoneal dialysis patients","volume":"47","author":"Schricker","year":"2022","journal-title":"Kidney Blood Press Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2018.10.106","article-title":"SGLT-2 inhibitors reduce glucose absorption from peritoneal dialysis solution by suppressing the activity of SGLT-2","volume":"109","author":"Zhou","year":"2019","journal-title":"BioMed Pharmacother"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/biom10111573","article-title":"SGLT2 inhibition by intraperitoneal dapagliflozin mitigates peritoneal fibrosis and ultrafiltration failure in a mouse model of chronic peritoneal exposure to high-glucose dialysate","volume":"10","author":"Balzer","year":"2020","journal-title":"Biomolecules"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.26502\/anu.2644-2833047","article-title":"The use of SGLT2 inhibitors in peritoneal dialysis patients: A shade of light on dapagliflozin","volume":"5","author":"Alhwiesh","year":"2022","journal-title":"Arch Nephrol Urol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s12882-023-03164-8","article-title":"SGLT-2 inhibitors may increase ultrafiltration in incident peritoneal dialysis patients: A case report","volume":"24","author":"Lai","year":"2023","journal-title":"BMC Nephrol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1186\/s12882-024-03683-y","article-title":"SGLT-2 inhibitors in chronic peritoneal dialysis patients: A follow-up study","volume":"25","author":"Lai","year":"2024","journal-title":"BMC Nephrol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60081198","article-title":"Effects of sodium-glucose cotransporter 2 inhibitors in diabetic and non-diabetic patients with advanced chronic kidney disease in peritoneal dialysis on residual kidney function: In real-world data","volume":"60","author":"Moral Berrio","year":"2024","journal-title":"Med (Kaunas)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000196","article-title":"Pharmacokinetic properties of dapagliflozin in hemodialysis and peritoneal dialysis patients","volume":"18","author":"Barreto","year":"2023","journal-title":"Clin J Am Soc Nephrol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-024-02467-w","article-title":"Effects of sodium-glucose co-transporter 2 inhibitors on ultrafiltration in patients with peritoneal dialysis: A protocol for a randomized, double-blind, placebo-controlled, crossover trial (EMPOWERED)","volume":"28","author":"Doi","year":"2024","journal-title":"Clin Exp Nephrol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfaf350","article-title":"SGLT2 inhibitors in hemodialysis or peritoneal dialysis patients: Rationale and state-of-the art","volume":"19","author":"Minutolo","year":"2025","journal-title":"Clin Kidney J"},{"key":"B19","unstructured":"Summary of Product Characteristics: Dapagliflozin"},{"key":"B20","unstructured":"Summary of Product Characteristics: Empagliflozin"}],"container-title":["Frontiers in Nephrology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneph.2026.1942462\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:33:57Z","timestamp":1790656437000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneph.2026.1942462\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":20,"alternative-id":["10.3389\/fneph.2026.1942462"],"URL":"https:\/\/doi.org\/10.3389\/fneph.2026.1942462","relation":{},"ISSN":["2813-0626"],"issn-type":[{"value":"2813-0626","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"1942462"}}