Understanding the protective effects of SGLT2 inhibitors in type 2 diabetes patients with chronic kidney disease.

Acute kidney injury; Albuminuria; Chronic kidney disease; Gliflozin; Heart failure; Mechanism; Nephroprotection; Renal outcome; SGLT2 inhibitor; Endocrinology, Diabetes and Metabolism

Abstract :

[en] INTRODUCTION: Sodium-glucose co-transporter type 2 inhibitors (SGLT2is) were developed as glucose-lowering agents for the management of type 2 diabetes (T2D). Unexpectedly, they showed a significant reduction in hospitalization for heart failure and hard renal outcomes in patients with and without T2D. Underlying mechanisms remain a matter of debate. AREAS COVERED: We summarize the protective renal effects of SGLT2is in patients with cardiovascular disease, chronic kidney disease (CKD, especially with albuminuria) or heart failure; a description of the safety of SGLT2is, with a special focus on the risk/benefit balance in people with stage 3 CKD; a comprehensive discussion of mechanisms that could explain nephro-protection; a reappraisal of the positioning of SGLT2is in recent international guidelines. EXPERT OPINION: Several mechanisms could contribute to improved renal prognosis with SGLT2is, among which a reduction in intraglomerular pressure by restoring the tubuloglomerular feedback, a diuretic effect that contributes to lower albuminuria and renal decongestion, especially if fluid overload is present, a reduction in renal oxygen consumption, an improvement of heart failure status with less cardiorenal syndrome and a lower risk of acute renal injury. All these effects may be mutually not exclusive, and their respective contribution may differ according to patient characteristics.

Disciplines :

Urology & nephrology
Pharmacy, pharmacology & toxicology
Endocrinology, metabolism & nutrition

Author, co-author :

SCHEEN, André ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques

DELANAYE, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie ; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France

Language :

English

Title :

Understanding the protective effects of SGLT2 inhibitors in type 2 diabetes patients with chronic kidney disease.

Publication date :

January 2022

Journal title :

Expert Review of Endocrinology and Metabolism

ISSN :

1744-6651

eISSN :

1744-8417

Publisher :

Taylor and Francis Ltd., England

Volume :

Issue :

Pages :

35-46

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://www.tandfonline.com/doi/pdf/10.1080/17446651.2022.2014322

Funding text :

The authors have no funding to report.

Available on ORBi :

since 11 April 2022

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