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    Renal effects of sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes and renal impairment

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    Author
    Weir, M.R.
    Date
    2019
    Journal
    Postgraduate Medicine
    Publisher
    Taylor and Francis Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1080/00325481.2019.1624582
    Abstract
    In patients with type 2 diabetes (T2D), microvascular changes in the kidney often result in diabetic kidney disease (DKD), the progression of which is associated with an increased risk of cardiovascular (CV) and all-cause mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are a newer class of oral glucose-lowering therapies that were associated with significant reductions in the risk of major adverse CV events, CV death, and hospitalization for heart failure compared with placebo in CV outcomes trials (CVOTs) of patients with T2D and established CV disease or varying levels of CV risk. In addition, SGLT-2is reduced the risks of clinically relevant renal outcomes in these large randomized studies, indicating the potential for renoprotective effects in patients with T2D and DKD. This review discussed the non-glycemic effects of SGLT-2is in patients with T2D and renal impairment, including reductions in systolic and diastolic blood pressure, decreases in albuminuria and plasma uric acid, changes in estimated glomerular filtration rate, and minimal changes in electrolytes. Potential mechanisms for the renoprotective effects of SGLT-2is observed in CVOTs were considered, including the likely incremental benefits of SGLT-2is when added to renin-aldosterone-angiotensin system inhibitors (RAASis). The possibility of extending the use of SGLT-2is to patients with non-DKD was also discussed. Although the exact mechanisms by which SGLT-2is improve renal outcomes are not fully understood, they are likely to be multifactorial and additive when these drugs are used in combination with RAASis in patients with DKD. Copyright 2019 The Author(s).
    Sponsors
    NIH grant funding R01 HL132732,U01 DK116095,R01 DK066013,R01 HL127422,U01 DK106102.
    Keyword
    Diabetic nephropathies
    renoprotective effects
    sodium-glucose cotransporter-2 inhibitors
    type 2 diabetes
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071978699&doi=10.1080%2f00325481.2019.1624582&partnerID=40&md5=ca0b02048df06d3d591b6d34ad8267f6; http://hdl.handle.net/10713/10854
    ae974a485f413a2113503eed53cd6c53
    10.1080/00325481.2019.1624582
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