Overhydration: A cause or an effect of kidney damage and how to treat it

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Volume overload is a significant complication in chronic kidney disease (CKD) and cardiovascular disease (CVD), often exacerbating renal insufficiency and impairing renal function.
• Fluid management is crucial, with salt restriction and loop diuretics as primary therapies, though diuretic resistance is a frequent challenge.
• Other interventions like ultrafiltration (UF), peritoneal dialysis (PD), and hemodialysis are employed for severe congestion unresponsive to diuretics.

Purpose of the Study:

• To review current therapeutic strategies for managing volume overload in CKD patients.
• To highlight the emerging role of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in fluid volume control and their cardio-renal protective effects.

Main Methods:

• Review of existing literature on fluid overload management in CKD.
• Analysis of clinical data and studies on the efficacy of diuretics, ultrafiltration, dialysis, and SGLT2 inhibitors.
• Synthesis of evidence regarding the impact of SGLT2 inhibitors on cardiovascular and renal outcomes.

Main Results:

• Diuretic resistance is common, necessitating alternative strategies such as intravenous diuretics, albumin, or advanced therapies like UF and dialysis.
• Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated a significant breakthrough in managing fluid volume in both diabetic and non-diabetic CKD patients.
• SGLT2 inhibitors exhibit notable cardio- and renoprotective effects, positively influencing major cardiovascular and renal endpoints.

Conclusions:

• Effective management of volume overload in CKD requires a multi-faceted approach, including pharmacological and non-pharmacological interventions.
• SGLT2 inhibitors represent a promising therapeutic advancement for fluid management in CKD, offering significant benefits for cardiovascular and renal health.
• The cardio- and renoprotective properties of SGLT2 inhibitors underscore their importance in improving long-term outcomes for patients with CKD.