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Do sodium-glucose cotransporter-2 inhibitors affect renal hemodynamics by different mechanisms in type 1 and type 2

Petter Bjornstad1, Robert G Nelson2, Meda E Pavkov3

  • 1Section of Endocrinology, Department of Pediatrics, Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.

Kidney International
|January 6, 2020
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors protect kidneys in type 2 diabetes by reducing hyperfiltration. This effect in older adults may involve post-glomerular vasodilation, differing from mechanisms in younger patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) show nephroprotective effects in type 2 diabetes (T2D).
  • Hyperfiltration attenuation is a proposed mechanism for SGLT2i-induced nephroprotection.
  • In type 1 diabetes, afferent arteriolar vasoconstriction via tubuloglomerular feedback is implicated in young adults.

Purpose of the Study:

  • To investigate the mechanism of glomerular filtration rate (GFR) attenuation by SGLT2i in older adults with T2D.
  • To determine if the mechanism observed in type 1 diabetes applies to older adults with T2D.

Main Methods:

  • The study by van Bommel et al. examined hemodynamic changes in the glomerulus.
  • Analysis focused on the role of afferent versus efferent arteriolar tone.

Main Results:

  • Older adults with T2D undergoing SGLT2i treatment showed attenuation of elevated GFR.
  • This attenuation was achieved through post-glomerular vasodilation, not afferent arteriolar vasoconstriction.
  • The findings suggest a different nephroprotective mechanism in this population compared to younger individuals with type 1 diabetes.

Conclusions:

  • The mechanism of SGLT2i-mediated nephroprotection in older adults with T2D differs from that observed in younger individuals with type 1 diabetes.
  • Post-glomerular vasodilation appears to be the key factor in attenuating hyperfiltration in this specific demographic.
  • These findings have implications for understanding and optimizing SGLT2i therapy in diverse patient groups.

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