SGLT2 Inhibitors and Kidney Disease
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SGLT2 inhibitors, originally developed for type 2 diabetes, are now showing promise in slowing the progression of chronic kidney disease (CKD), even in people without diabetes.
Clinical Trial Results
A major clinical trial demonstrated that dapagliflozin, an SGLT2 inhibitor, reduced the risk of kidney disease progression and slowed kidney function loss when added to standard CKD treatment. specifically, the DAPA-CKD trial, published in the New England Journal of Medicine on May 20, 2021, showed a 39% reduction in the composite outcome of worsening kidney function or kidney failure in patients treated with dapagliflozin compared to placebo. [8] Researchers also observed that among participants with IgA nephropathy (IgAN), a specific type of kidney disease, fewer people taking dapagliflozin experienced serious kidney problems, such as critically important kidney function decline or kidney failure, compared to those taking a placebo.
How SGLT2 Inhibitors Protect kidneys
SGLT2 inhibitors work by blocking the reabsorption of glucose in the kidneys,causing excess glucose to be excreted in the urine. While initially intended to lower blood sugar, this mechanism also reduces pressure within the glomeruli – the filtering units of the kidneys – and decreases inflammation. This reduction in pressure and inflammation appears to be protective against kidney damage. Researchers noticed that kidney function declined more slowly than expected in manny diabetes patients taking these medications, prompting further investigation into their potential benefits for CKD. [7]
Who Can benefit?
Clinical trials have focused on individuals with chronic kidney disease, both with and without type 2 diabetes. The DAPA-CKD trial included 4,304 participants with CKD and urinary albumin excretion, regardless of their diabetes status. The positive results suggest that SGLT2 inhibitors may be beneficial for a broader range of patients with CKD than previously thought. However, it’s crucial to discuss the risks and benefits with a healthcare provider to determine if an SGLT2 inhibitor is appropriate.
