Luxcia Kugathasan, Ph.D.
Supervisor(s): Dr. David Cherney
Award: KRESCENT Post-Doctoral Fellowship
Institution: University Health Network
Year: 2026-2029
Project Title: Protecting Kidneys in Type 2 Diabetes: Exploring an Affordable New Option with Acetazolamide
Topic(s): Chronic Kidney Disease
Biography
Luxcia Kugathasan is a Postdoctoral Fellow working with Dr. David Cherney in the Renal Physiology Laboratory at Toronto General Hospital, University Health Network. Her research focuses on the mechanisms underlying cardio-kidney-metabolic disease, with a particular emphasis on sodium-glucose cotransporter-2 (SGLT2) inhibitors and novel therapeutic strategies for chronic kidney disease and diabetes. Her work integrates physiological, biomarker, and patient-centered approaches to improve outcomes for individuals at high cardiovascular and kidney risk. She is committed to advancing equitable, evidence-based kidney care through research, mentorship, and community engagement.
Lay Summary
Background: Nearly 1 in 2 Canadians living with type 2 diabetes (T2D) also have kidney disease. The development of kidney disease significantly limits patient quality and quantity of life, and places a large burden on the healthcare system. Current treatments can help slow down kidney damage, but do not fully target the root cause of the disease. Our research focuses on one early cause of kidney damage called hyperfiltration – this is when the kidneys work too hard and filter blood too quickly. Overtime, this leads to high blood pressure within the kidneys' delicate filtering units, causing protein leakage into the urine and loss of kidney function.
Purpose: Our study will test whether a low-cost drug called acetazolamide can reduce hyperfiltration and prevention kidney damage. Acetazolamide works by changing how the kidneys handle sodium, which may help reduce hyperfiltration. We are especially interested in how acetazolamide might work alongside dapagliflozin, a medication class already approved for people with T2D and known to protect the kidneys. Dapagliflozin also changes how the kidneys handle sodium and lowers hyperfiltration, but through a different target. Method: We propose a 12-week, multi-centre study in people with T2D and early signs of kidney disease to test whether acetazolamide provides additional kidney benefits when added to standard treatment with the SGLT2 inhibitor dapagliflozin. A total of 64 participants will be recruited from Toronto General Hospital, St. Paul’s Hospital, and Vancouver General Hospital. All participants will already be taking dapagliflozin and will be randomly assigned to receive either acetazolamide or a placebo for 12 weeks, without knowing which treatment they are receiving. Kidney function and other health measures will be assessed after 2 weeks of treatment, after 12 weeks of treatment, and again 2 weeks after stopping the study medication. We will closely monitor kidney function, urine protein levels, blood pressure, heart and kidney health markers, and medication safety to understand how acetazolamide affects the kidneys when used alongside dapagliflozin.
Anticipated Outcomes: We anticipate that adding acetazolamide to dapagliflozin will temporarily lower kidney filtration pressure, followed by stabilization over time. We also expect acetazolamide to reduce protein leakage in the urine, an important marker of kidney damage, while being safe and well tolerated. The results of this study will provide important information about whether acetazolamide could be a useful additional treatment to protect kidney health in people with T2D. These findings will help guide the design of larger future trials aimed at slowing kidney disease progression and improving long-term heart and kidney outcomes in high-risk populations.
Patient Engagement: We are working closely with our patient partners who have lived experience with diabetes and kidney disease. From the start, they helped shape the study by advising on visit schedules, communication materials, and the overall focus of the research. Their voices helped us ensure this study reflects real-world priorities and concerns. Our patient partners will also help us explain the results in clear, meaningful ways – like creating videos, infographics, and handouts – so that the information is accessible and useful to other patients, families, and communities.
Relevance to Patients/Community: Cost is a major barrier to care. Many drugs for kidney disease cost thousands of dollars each year and may not be fully covered by insurance. Our patient partners have described this financial strain as overwhelming, stating that “we just want something that works and is affordable”. Acetazolamide is off-patent and, if proven to be effective alongside current therapies, offers an inexpensive new therapy to protect kidney function. Our research addresses not just a medical gap, but a social one: making kidney care more accessible for everyone, not just those who can afford expensive medications.
Conclusion: This study will be the first to explore acetazolamide on top of dapagliflozin in people with T2D. If acetazolamide proves effective, it could offer a new, affordable treatment option for people with T2D to prevent the development of kidney failure. This could help protect kidney function, reduce the need for costly treatments, and ease pressure on healthcare systems. In the long run, this study has the potential to improve the health and well-being of many people living with kidney disease and diabetes.