SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects

Medicina (Kaunas). 2019 Jun 11;55(6):268. doi: 10.3390/medicina55060268.

Abstract

The burden of diabetic kidney disease (DKD) has increased worldwide in the last two decades. Besides the growth of diabetic population, the main contributors to this phenomenon are the absence of novel nephroprotective drugs and the limited efficacy of those currently available, that is, the inhibitors of renin-angiotensin system. Nephroprotection in DKD therefore remains a major unmet need. Three recent trials testing effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2-i) have produced great expectations on this therapy by consistently evidencing positive effects on hyperglycemia control, and more importantly, on the cardiovascular outcome of type 2 diabetes mellitus. Notably, these trials also disclosed nephroprotective effects when renal outcomes (glomerular filtration rate and albuminuria) were analyzed as secondary endpoints. On the other hand, the use of SGLT2-i can be potentially associated with some adverse effects. However, the balance between positive and negative effects is in favor of the former. The recent results of Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation Study and of other trials specifically testing these drugs in the population with chronic kidney disease, either diabetic or non-diabetic, do contribute to further improving our knowledge of these antihyperglycemic drugs. Here, we review the current state of the art of SGLT2-i by addressing all aspects of therapy, from the pathophysiological basis to clinical effectiveness.

Keywords: GFR; SGLT-2 inhibitors; albuminuria; chronic kidney disease; diabetes; end stage renal disease; survival.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / etiology
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetic Ketoacidosis / etiology
  • Diabetic Nephropathies / drug therapy*
  • Fractures, Bone / etiology
  • Humans
  • Infections / etiology
  • Neuroprotective Agents / adverse effects
  • Neuroprotective Agents / pharmacology
  • Neuroprotective Agents / therapeutic use
  • Sodium-Glucose Transporter 2 Inhibitors / adverse effects
  • Sodium-Glucose Transporter 2 Inhibitors / pharmacology*
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use
  • Treatment Outcome
  • Urinary Tract Infections / etiology

Substances

  • Neuroprotective Agents
  • Sodium-Glucose Transporter 2 Inhibitors