Key result
SGLT2 inhibitors prevent albuminuria progression and delay ESRD in diabetic kidney disease.
Why the study?
Despite optimal management of diabetic kidney disease, the residual risk for nephropathy progression to end-stage renal disease remains high, prompting investigation of SGLT-2 inhibitors' renoprotective effects.
Do SGLT-2 inhibitors provide renoprotective effects and prevent progression to ESRD in diabetic kidney disease?
Systematic Review
Do SGLT-2 inhibitors provide renoprotective effects and prevent progression to ESRD in diabetic kidney disease?
SGLT-2 inhibitors offer significant cardio-renal protection in diabetic kidney disease through mechanisms extending beyond glycemic control, including attenuation of glomerular hyperfiltration.
Answers are grounded in this paper and cite their sources.
SGLT-2 inhibitors merit routine use in diabetic kidney disease to delay ESRD; confirms renoprotection in Level 1 evidence synthesis.
BACKGROUND: Despite optimal management of diabetic kidney disease (DKD) with intensive glycemic control and administration of agents blocking the renin-angiotensinaldosterone- system, the residual risk for nephropathy progression to end-stage-renal-disease (ESRD) remains high. Sodium-glucose co-transporter type 2 (SGLT-2)-inhibitors represent a newly-introduced anti-diabetic drug class with pleiotropic actions extending above their glucose-lowering efficacy. Herein, we provide an overview of preclinical and clinical-trial evidence supporting a protective effect of SGLT-2 inhibitors on DKD. METHODS: A systematic literature search of bibliographic databases was conducted to identify preclinical studies and randomized trials evaluating the effects SGLT-2 inhibitors on DKD. RESULTS: Preclinical studies performed in animal models of DKD support the renoprotective action of SGLT-2 inhibitors showing that these agents exert albuminuria-lowering effects and reverse glomerulosclerosis. The renoprotective action of SGLT-2 inhibitors is strongly supported by human studies showing that these agents prevent the progression of albuminuria and retard nephropathy progression to ESRD. This beneficial effect of SGLT-2 inhibitors is not fully explained by their glucose-lowering properties. Attenuation of glomerular hyperfiltration and improvement in a number of surrogate risk factors, including associated reduction in systemic blood pressure, body weight, and serum uric acid levels may represent plausible mechanistic explanations for the cardio-renal protection offered by SGLT-2 inhibitors. Furthermore, the tubular cell metabolism seems to be altered towards a ketone-prone pathway with protective activities. CONCLUSION: SGLT-2 inhibition emerges as a novel therapeutic approach of diabetic with anticipated benefits towards cardio-renal risk reduction. Additional research efforts are clearly warranted to elucidate this favorable effect in patients with overt DKD.
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Georgianos et al. (2018) conducted a systematic review in Diabetic Kidney Disease. SGLT-2 inhibitors was evaluated. SGLT-2 inhibitors prevent the progression of albuminuria and retard nephropathy progression to end-stage renal disease in diabetic kidney disease.
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