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The rationale for the need to study sodium-glucose co-transport 2 inhibitor usage in peritoneal dialysis patients

Megan Borkum1, Abeed Jamal1, Rajinder Suneet Singh1

  • 1Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|May 2, 2022
PubMed

Insights

Sodium-glucose co-transport 2 (SGLT2) inhibitors show promise for dialysis patients, a high-risk group excluded from trials. Further research is needed to confirm their cardiovascular and kidney benefits in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Sodium-glucose co-transport 2 (SGLT2) inhibitors have demonstrated significant kidney and heart benefits in clinical trials.
  • However, these trials excluded patients with estimated glomerular filtration rates below 25 ml/min/1.73 m².
  • Dialysis patients represent a population at high risk for cardiovascular disease who could potentially benefit from SGLT2 inhibitors.

Purpose of the Study:

  • To explore the potential benefits of SGLT2 inhibitors in patients undergoing dialysis.
  • To investigate the efficacy of SGLT2 inhibitors in preserving residual kidney function (RKF) and protecting the peritoneal membrane in peritoneal dialysis (PD) patients.
  • To highlight the need for randomized controlled trials (RCTs) in PD patients using SGLT2 inhibitors.

Main Methods:

  • Review of emerging evidence from experimental studies and post hoc analyses of randomized clinical trials.
  • Analysis of physiological rationale and clinical need for SGLT2 inhibitor use in dialysis patients.
  • Identification of gaps in current research regarding SGLT2 inhibitors in severe chronic kidney disease and dialysis.

Main Results:

  • Emerging evidence suggests SGLT2 inhibitors are well-tolerated and potentially effective in reducing cardiovascular and mortality outcomes in severe CKD, including dialysis patients.
  • Experimental data indicate SGLT2 inhibitors may preserve RKF and protect the peritoneal membrane in PD patients.
  • There is a clear rationale and urgent need for RCTs to evaluate SGLT2 inhibitors in PD patients.

Conclusions:

  • SGLT2 inhibitors could represent a major advancement in the care of dialysis patients by offering cardioprotective and kidney-protective benefits.
  • Preserving RKF and reducing transfer to hemodialysis are critical unmet needs in PD patients that SGLT2 inhibitors might address.
  • Robust RCTs are essential to definitively establish the safety and efficacy of SGLT2 inhibitors in peritoneal dialysis patients.
Keywords:
CardioprotectiveSGLT2 inhibitorperitoneal dialysisresidual kidney function

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