SGLT2 Inhibitors in Diabetic and Non-Diabetic Chronic Kidney Disease

Results from recent randomized controlled trials on inhibitors of the sodium-glucose cotransporter 2 (SGLT2) have determined a paradigm shift in the treatment of patients with type 2 diabetes mellitus. These agents have been shown not only to ameliorate metabolic control, but also to independently protect from cardiovascular events and to reduce the progression of chronic kidney disease (CKD) in these patients. The magnitude of the nephroprotective effect observed in these studies is likely to make SGLT2 inhibitors the most impactful drug class for the treatment of diabetic patients with CKD since the discovery of renin-angiotensin system inhibitors. Even more surprisingly, SGLT2 inhibitors have also been shown to slow CKD progression in non-diabetic individuals with varying degrees of proteinuria, suggesting that activation of SGLT2 is involved in the pathogenesis of CKD independent of its etiology. As indications continue to expand, it is still unclear whether the observed benefits of SGLT2 inhibitors may extend to CKD patients at lower risk of progression and if their association with other agents may confer additional protection.

Automated summary

Results from recent trials have shown that SGLT2 inhibitors have brought a paradigm shift in the treatment of type 2 diabetes mellitus. These drugs not only improve metabolic control, but also independently protect patients from cardiovascular events and slow the progression of chronic kidney disease (CKD). The observed nephroprotective effect of SGLT2 inhibitors may make them the most impactful drug class for diabetic patients with CKD. Furthermore, these inhibitors have also been shown to slow CKD progression in non-diabetic individuals with proteinuria, suggesting a broader involvement of SGLT2 in the pathogenesis of CKD.