DPP-4 inhibition promotes a distal tubular natriuresis in conjunction with increased levels of intact SDF-1α. Because of the distal location of the natriuretic effect, DPP-4 inhibition does not affect tubuloglomerular feedback or impair renal hemodynamic function, findings relevant to using DPP-4 inhibitors for treating type 2 diabetes.

Inhibition of sodium-glucose cotransporter 2 causes both glycosuria and natriuresis, leading to reductions in hyperglycemia, body weight, blood pressure, and proteinuria. The recently published EMPA-REG OUTCOME study demonstrated significant cardiovascular and mortality benefits of sodium-glucose cotransporter 2 inhibition with empagliflozin in patients with type 2 diabetes and established cardiovascular disease, and may suggest a broader role for sodium-glucose cotransporter 2 inhibition in patients with heart failure.

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