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Sodium-glucose cotransporter 2 inhibitors for diabetic kidney disease: a primer for deprescribing

Jiahua Li1,2, Christopher O Fagbote3, Min Zhuo4

  • 1Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Clinical Kidney Journal
|October 5, 2019
PubMed

Insights

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) show promise in managing diabetic chronic kidney disease (CKD) by offering cardiovascular and renal protection. This review explores their role in reducing polypharmacy and managing comorbidities, while considering potential adverse effects.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Chronic kidney disease (CKD) presents significant global health challenges, marked by high morbidity, mortality, and increased healthcare costs.
  • Managing CKD and its comorbidities often results in polypharmacy, further exacerbating patient health issues.
  • Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated substantial cardiovascular and renal protective benefits in type 2 diabetes mellitus (T2DM).

Purpose of the Study:

  • To review the cardiovascular and renal protective effects of SGLT2is in diabetic CKD patients.
  • To discuss the role of SGLT2is in managing associated comorbidities and reducing polypharmacy.
  • To examine the adverse effects and controversies surrounding SGLT2is in diabetic CKD.

Main Methods:

  • Case presentation of a complex diabetic CKD patient with multiple comorbidities.
  • Review of clinical trial data and current guidelines on SGLT2i use.
  • Discussion of SGLT2i's pleiotropic effects beyond glycosuria.

Main Results:

  • SGLT2is offer significant cardiovascular and renal protection in T2DM patients.
  • Potential for SGLT2is to reduce polypharmacy in diabetic CKD by managing multiple conditions.
  • Consideration of adverse effects and controversies is crucial for safe SGLT2i initiation.

Conclusions:

  • SGLT2is represent a promising therapeutic option for diabetic CKD, offering multifaceted benefits.
  • Careful consideration of patient comorbidities and potential adverse effects is essential.
  • Deprescribing principles should guide the initiation of SGLT2is in this complex patient population.

Keywords:
chronic kidney diseasedeprescribingdiabetic kidney diseasepolypharmacysodium-glucose cotransporter 2

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