Related Experiment Videos
Hugo Bakis1, Pierre Pfirmann1, Christian Combe2
1Service de néphrologie, transplantation, dialyse et aphérèses, CHU de Bordeaux, F-33000 Bordeaux, France.
Abstract:
Inhibitors of sodium glucose co-transporter type 2 (iSGLT2) constitute a considerable advance in the management of patients with diabetes, heart failure and with chronic kidney disease (CKD). Randomized controlled studies have shown a significant reduction of cardiovascular risk in diabetic type 2 and/or heart failure with reduced ejection fraction patients. These studies observed a risk reduction of worsening nephropathy, leading to randomized controlled studies in CKD patients : CREDENCE, DAPA-CKD and EMPA-KIDNEY. iSGLT2 are associated with a slower progression toward end-stage kidney disease, a lower slope of GFR and a lower rate of albuminuria. In CKD patients with proteinuria either diabetic or not, the DAPA-CKD and the EMPA-KIDNEY studies have demonstrated a nephroprotective effect. This effect has not been found for patients without proteinuria. For the other nephropathies, further studies are required to confirm results obtained in patients without type 2 diabetes and macroalbuminuria. Therefore, the indication of iSGLT2, with appropriate dose of RAS inhibitor, seems undeniable to an optimal nephroprotection in CKD patients with type 2 diabetes and/or albuminuria and/or heart failure. They must be prescribed in addition to conventional nephroprotective and cardioprotective treatments and care. Side effects are limited. However, special education and monitoring concerning risks of genital infection and euglycemic ketoacidosis (diabetic patients) must be taken in mind. The therapeutic arsenal for CKD patients is expanding, leading to consider a personalized care according to the underlying nephropathy. © 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.
Insights
Sodium glucose co-transporter type 2 inhibitors (iSGLT2) offer significant cardiovascular and kidney protection for patients with diabetes, heart failure, and chronic kidney disease (CKD). These iSGLT2 medications slow CKD progression and reduce albuminuria, particularly in patients with proteinuria.
Area of Science:
- Nephrology and Endocrinology
- Pharmacology of glucose metabolism and cardiovascular/renal protection
Context:
- Sodium glucose co-transporter type 2 inhibitors (iSGLT2) represent a therapeutic breakthrough for managing complex conditions.
- Evidence from randomized controlled trials demonstrates iSGLT2 efficacy in reducing cardiovascular risk in type 2 diabetes and heart failure.
- Clinical studies like CREDENCE, DAPA-CKD, and EMPA-KIDNEY specifically investigated iSGLT2 benefits in chronic kidney disease (CKD).
Purpose:
- To evaluate the nephroprotective effects of iSGLT2 in patients with chronic kidney disease (CKD).
- To assess the impact of iSGLT2 on the progression of kidney disease, glomerular filtration rate (GFR), and albuminuria.
- To review the benefits and risks of iSGLT2 in diverse CKD populations, including those with and without proteinuria.
Summary:
- iSGLT2 significantly slow the progression of CKD, reduce the decline in GFR, and decrease albuminuria.
- Nephroprotective effects are evident in CKD patients with proteinuria, regardless of diabetes status, as shown in DAPA-CKD and EMPA-KIDNEY.
- iSGLT2 are recommended for optimal nephroprotection in CKD patients with type 2 diabetes, albuminuria, or heart failure, alongside RAS inhibitors and standard care.
Impact:
- iSGLT2 expand the therapeutic options for CKD management, offering significant renal and cardiovascular benefits.
- Personalized patient care considering underlying nephropathy is crucial for optimizing iSGLT2 therapy.
- Monitoring for potential side effects like genital infections and euglycemic ketoacidosis is essential, particularly in diabetic patients.