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Sodium-glucose cotransporter 2 inhibition: which patient with chronic kidney disease should be treated in the future?

Brendon L Neuen1, Meg J Jardine1, Vlado Perkovic1

  • 1George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|February 1, 2020
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors offer significant benefits for type 2 diabetes (T2DM) and chronic kidney disease (CKD). These drugs prevent kidney failure and cardiovascular events, even with standard care.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiology

Background:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a significant advancement for managing type 2 diabetes (T2DM) and chronic kidney disease (CKD).
  • The CREDENCE trial demonstrated canagliflozin's efficacy in preventing kidney failure and cardiovascular events in T2DM patients with CKD.

Purpose of the Study:

  • To review the evidence for SGLT2 inhibition in T2DM and CKD patients.
  • To evaluate patient characteristics and drug interactions influencing SGLT2 inhibitor use in CKD.
  • To discuss current guidelines and future applications of SGLT2 inhibitors in CKD management.

Main Methods:

  • Review of large-scale randomized trials, including CREDENCE.
  • Analysis of ongoing trials like DAPA-CKD and EMPA-KIDNEY.
  • Evaluation of patient-specific factors and concomitant medications.

Main Results:

  • SGLT2 inhibition demonstrates benefits for major kidney outcomes in T2DM patients with CKD.
  • These benefits are observed in addition to existing standard care treatments.
  • Evidence suggests potential class-wide effects of SGLT2 inhibitors on kidney outcomes.

Conclusions:

  • SGLT2 inhibitors represent a major therapeutic advance for T2DM and CKD.
  • Further trials will confirm class-wide effects and inform future treatment strategies.
  • Personalized approaches considering patient characteristics and drug combinations will optimize SGLT2 inhibitor use in CKD.
Keywords:
SGLT2 inhibitorschronic kidney diseaseclinical outcomestype 2 diabetes

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