SGLT2 Inhibitors in Kidney Diseases-A Narrative Review

Abstract

Some of the most common conditions affecting people are kidney diseases. Among them, we distinguish chronic kidney disease and acute kidney injury. Both entities pose serious health risks, so new drugs are still being sought to treat and prevent them. In recent years, such a role has begun to be assigned to sodium-glucose cotransporter-2 (SGLT2) inhibitors. They increase the amount of glucose excreted in the urine. For this reason, they are currently used as a first-line drug in type 2 diabetes mellitus. Due to their demonstrated cardioprotective effect, they are also used in heart failure treatment. As for the renal effects of SGLT2 inhibitors, they reduce intraglomerular pressure and decrease albuminuria. This results in a slower decline in glomelular filtration rate (GFR) in patients with kidney disease. In addition, these drugs have anti-inflammatory and antifibrotic effects. In the following article, we review the evidence for the effectiveness of this group of drugs in kidney disease and their nephroprotective effect. Further research is still needed, but meta-analyses indicate SGLT2 inhibitors' efficacy in kidney disease, especially the one caused by diabetes. Development of new drugs and clinical trials on specific patient subgroups will further refine their nephroprotective effects.

Keywords: SGLT2 inhibitors; acute kidney injury; chronic kidney disease; nephroprotection.

Figure 1

Transport of sodium and glucose in the proximal tubule. SGLT2—sodium-glucose cotransporter-2 inhibitor; GLUT2—glucose transporter 2; ATPase—sodium–potassium adenosine triphosphatase.

Figure 2

Pleiotropic effect of SGLT2 inhibitors on the body. eGFR—estimated glomelural filtration; HbA1c—glycated hemoglobin.