Kidney and cardiovascular protection with SGLT2 inhibitors: lessons from cardiovascular outcome trials and CREDENCE

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Diabetic kidney disease (DKD) poses a growing global health challenge, necessitating novel therapeutic strategies.
• Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a promising class of glucose-lowering agents with demonstrated cardioprotective and nephroprotective effects.
• Recent evidence suggests SGLT2 inhibitors may also benefit patients with non-diabetic chronic kidney disease (CKD).

Purpose of the Study:

• To review the current evidence on the benefits and risks of SGLT2 inhibitors in kidney disease.
• To identify patient populations most likely to benefit from SGLT2 inhibitor therapy.
• To explore the expanding role of SGLT2 inhibitors beyond diabetes management.

Main Methods:

• Systematic review of large cardiovascular outcome trials (CVOTs).
• Analysis of dedicated kidney outcome trials (KOTs) and heart failure trials.
• Evaluation of emerging evidence in non-diabetic CKD populations.

Main Results:

• SGLT2 inhibitors have demonstrated substantial clinical benefits in reducing adverse cardiovascular and kidney events in multiple large-scale trials.
• Consistent efficacy observed across different SGLT2 inhibitor agents.
• Growing evidence supports potential renoprotective and cardioprotective effects in non-diabetic CKD.

Conclusions:

• SGLT2 inhibitors are effective in mitigating risks associated with diabetic kidney disease and cardiovascular events.
• The therapeutic potential of SGLT2 inhibitors may extend to patients with non-diabetic chronic kidney disease.
• Further research is warranted to define optimal patient selection and long-term outcomes for SGLT2 inhibitor use in diverse CKD populations.