Key result
SGLT2 inhibitors and GLP-1 receptor agonists exert nephroprotective effects independently of glucose-lowering activity, reducing progression to end-stage renal disease in type 2 diabetes.
Why the study?
Chronic kidney disease represents a major burden in type 2 diabetes, prompting this review to evaluate the add-on value of new glucose-lowering agents compared or combined with RAAS inhibitors on renal outcomes.
Do new glucose-lowering agents (GLP-1 receptor agonists and SGLT2 inhibitors) improve renal outcomes in patients with type 2 diabetes when compared or combined with RAAS inhibitors?
Do new glucose-lowering agents (GLP-1 receptor agonists and SGLT2 inhibitors) improve renal outcomes in patients with type 2 diabetes when compared or combined with RAAS inhibitors?
SGLT2 inhibitors and GLP-1 receptor agonists provide significant renoprotective effects in patients with type 2 diabetes, supporting their use alongside RAAS inhibitors.
INTRODUCTION: Chronic kidney disease (CKD) represents a huge burden in patients with type 2 diabetes (T2DM). This review therefore has the aim of assessing the add-on value of new glucose-lowering agents compared or combined with inhibitors of the renin angiotensin aldosterone system (RAAS) on renal outcomes in T2DM patients. AREAS COVERED: This article first summarizes the results reported with RAAS inhibitors, mainstay of nephroprotection in T2DM with albuminuria. Second, it describes the positive results with glucagon-like peptide-1 receptor agonists (GLP-1RAs) and, even more impressive, sodium-glucose cotransporter type 2 inhibitors (SGLT2is). Third, besides the potential of combined therapies, it briefly considers some new approaches currently in development. EXPERT OPINION: RAAS inhibitors exert renoprotective effects beyond their blood pressure lowering effects while SGLT2is, and possibly GLP-1RAs, exert nephroprotection independently of their glucose-lowering activity. These effects were demonstrated not only on surrogate endpoints such as albuminuria and estimated glomerular filtration rate decline, but also on hard endpoints, including progression to end-stage renal disease requiring replacement therapy. The underlying mechanisms are different and potentially complementary on glomerular hemodynamics, arguing for combined therapies. Nevertheless, there is still room for new emerging drugs to tackle CKD in T2DM.
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Delanaye et al. (2018) conducted a review in Type 2 diabetes and chronic kidney disease. GLP-1 receptor agonists and SGLT2 inhibitors vs. RAAS inhibitors or combined therapy was evaluated on Renal outcomes including albuminuria, eGFR decline, and progression to end-stage renal disease. SGLT2 inhibitors and GLP-1 receptor agonists exert nephroprotective effects independently of glucose-lowering activity, reducing progression to end-stage renal disease in type 2 diabetes.
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