Sodium‐glucose co‐transporter 2 inhibitor therapy: use in chronic kidney disease and adjunctive sodium restriction

Abstract

The global burden of chronic kidney disease (CKD) has increased significantly over the past few decades. This reflects the rising prevalence of type 2 diabetes mellitus (T2DM) and hypertension, two leading causes of CKD. Hypertension, which can also be a complication of CKD, accelerates renal disease progression and augments cardiovascular risk, especially in individuals with diabetic kidney disease. Hence, blood pressure (BP) reduction is a vital component of CKD management. Sodium‐glucose co‐transporter 2 (SGLT2) inhibitors are a relatively novel class of medications developed to treat T2DM by inducing glycosuria and hence, lowering glycaemia. Additionally, SGLT2 inhibitors are antihypertensive, renoprotective and cardioprotective, even in individuals without T2DM, making them effective therapeutic agents for CKD. Another therapy that has proven to be antihypertensive, renoprotective and cardioprotective is dietary sodium restriction. This review evaluates the potential combined benefits of SGLT2 inhibition and dietary sodium restriction on the BP and renal parameters of individuals with CKD.

‘We are somehow fixated on this being a diabetes drug’: a qualitative study exploring the views of cardiologists and nephrologists about sodium‐glucose cotransporter 2 inhibitor initiation

“…33 The rationale for this statement is that whilst SGLT2i have been shown to reduce the risk of AKI, these drugs have a diuretic action. [34][35][36] A review by Yau et al 35 provides some guidance about renal function monitoring following SGLT2i initiation in patients with CKD, which is not addressed in the KDIGO guideline. The medical community may benefit from more detailed information from international expert nephrologists about the methods of safely initiating SGLT2i in patients with moderate-severe CKD.…”

“…For such patients, reducing the dose of diuretics may be reasonable, and follow‐up should be arranged to monitor volume status’ 33 . The rationale for this statement is that whilst SGLT2i have been shown to reduce the risk of AKI, these drugs have a diuretic action 34–36 . A review by Yau et al 35 .…”

Research progress on the role of extracellular vesicles in the pathogenesis of diabetic kidney disease

“…At present, the treatments for DKD mainly include dietary intervention, control of blood glucose and blood pressure, improvement of albuminuria, and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors. In recent years, a variety of new hypoglycemic drugs, including sodium-dependent glucose transporter-2 (SGLT-2) inhibitors [ 6 ] and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have been reported to have renal protective effects [ 7 ]. These therapies have certain limitations and side effects, and clinical application can cause dry cough, abnormal blood potassium and other adverse reactions.…”