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Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations
SGLT2 inhibitors have emerged as a key disease-modifying therapy to prevent the progression of chronic kidney disease (CKD). These agents prevent decline in kidney function through reduction in glomerular hypertension mediated through tubuloglomerular feedback independent of their effect on glycemic...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9263228/ https://www.ncbi.nlm.nih.gov/pubmed/35812300 http://dx.doi.org/10.1016/j.ekir.2022.04.094 |
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author | Yau, Kevin Dharia, Atit Alrowiyti, Ibrahim Cherney, David Z.I. |
author_facet | Yau, Kevin Dharia, Atit Alrowiyti, Ibrahim Cherney, David Z.I. |
author_sort | Yau, Kevin |
collection | PubMed |
description | SGLT2 inhibitors have emerged as a key disease-modifying therapy to prevent the progression of chronic kidney disease (CKD). These agents prevent decline in kidney function through reduction in glomerular hypertension mediated through tubuloglomerular feedback independent of their effect on glycemic control. The proliferation of clinical trials on SGLT2 inhibitors has rapidly expanded the approved clinical indications for these agents beyond patients with diabetes mellitus (DM). We review the current indications for SGLT2 inhibitors in patients with and without diabetic kidney disease, including new evidence for use in patients with heart failure with or without reduced ejection fraction, stage 4 CKD, and chronic glomerulonephritis. The EMPA-KIDNEY trial was recently stopped early for efficacy suggesting that SGLT2 inhibitors may soon be indicated for patients with CKD without albuminuria. We review practical considerations for prescription of SGLT2 inhibitors, including the anticipated acute decline in estimated glomerular filtration rate (eGFR) on initiation, initiating the lowest dosage used in clinical trials, volume status considerations, and adverse event mitigation. Combination therapy in patients with DM may be considered with agents, including glucagon-like peptide-1 receptor agonists (GLP-1-RAs), novel mineralocorticoid receptor antagonists, and selective endothelin receptor antagonists to reduce residual albuminuria and cardiovascular risk. |
format | Online Article Text |
id | pubmed-9263228 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-92632282022-07-09 Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations Yau, Kevin Dharia, Atit Alrowiyti, Ibrahim Cherney, David Z.I. Kidney Int Rep Review SGLT2 inhibitors have emerged as a key disease-modifying therapy to prevent the progression of chronic kidney disease (CKD). These agents prevent decline in kidney function through reduction in glomerular hypertension mediated through tubuloglomerular feedback independent of their effect on glycemic control. The proliferation of clinical trials on SGLT2 inhibitors has rapidly expanded the approved clinical indications for these agents beyond patients with diabetes mellitus (DM). We review the current indications for SGLT2 inhibitors in patients with and without diabetic kidney disease, including new evidence for use in patients with heart failure with or without reduced ejection fraction, stage 4 CKD, and chronic glomerulonephritis. The EMPA-KIDNEY trial was recently stopped early for efficacy suggesting that SGLT2 inhibitors may soon be indicated for patients with CKD without albuminuria. We review practical considerations for prescription of SGLT2 inhibitors, including the anticipated acute decline in estimated glomerular filtration rate (eGFR) on initiation, initiating the lowest dosage used in clinical trials, volume status considerations, and adverse event mitigation. Combination therapy in patients with DM may be considered with agents, including glucagon-like peptide-1 receptor agonists (GLP-1-RAs), novel mineralocorticoid receptor antagonists, and selective endothelin receptor antagonists to reduce residual albuminuria and cardiovascular risk. Elsevier 2022-05-05 /pmc/articles/PMC9263228/ /pubmed/35812300 http://dx.doi.org/10.1016/j.ekir.2022.04.094 Text en © 2022 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Review Yau, Kevin Dharia, Atit Alrowiyti, Ibrahim Cherney, David Z.I. Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations |
title | Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations |
title_full | Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations |
title_fullStr | Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations |
title_full_unstemmed | Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations |
title_short | Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations |
title_sort | prescribing sglt2 inhibitors in patients with ckd: expanding indications and practical considerations |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9263228/ https://www.ncbi.nlm.nih.gov/pubmed/35812300 http://dx.doi.org/10.1016/j.ekir.2022.04.094 |
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