Renoprotection with SGLT2 inhibitors in type 2 diabetes over a spectrum of cardiovascular and renal risk
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(2020) 19:196 Giorgino et al. Cardiovasc Diabetol https://doi.org/10.1186/s12933-020-01163-9
Open Access
REVIEW
Renoprotection with SGLT2 inhibitors in type 2 diabetes over a spectrum of cardiovascular and renal risk Francesco Giorgino1* , Jiten Vora2, Peter Fenici3 and Anna Solini4
Abstract Approximately half of all patients with type 2 diabetes (T2D) develop a certain degree of renal impairment. In many of them, chronic kidney disease (CKD) progresses over time, eventually leading to end-stage kidney disease (ESKD) requiring dialysis and conveying a substantially increased risk of cardiovascular morbidity and mortality. Even with widespread use of renin–angiotensin system blockers and tight glycemic control, a substantial residual risk of nephropathy progression remains. Recent cardiovascular outcomes trials investigating sodium–glucose cotransporter 2 (SGLT2) inhibitors have suggested that these therapies have renoprotective effects distinct from their glucoselowering action, including the potential to reduce the rates of ESKD and acute kidney injury. Although patients in most cardiovascular outcomes trials had higher prevalence of existing cardiovascular disease compared with those normally seen in clinical practice, the proportion of patients with renal impairment was similar to that observed in a real-world context. Patient cardiovascular risk profiles did not relevantly impact the renoprotective benefits observed in these studies. Benefits were observed in patients across a spectrum of renal risk, but were evident also in those without renal damage, suggesting a role for SGLT2 inhibition in the prevention of CKD in people with T2D. In addition, recent studies such as CREDENCE and DAPA-CKD offer a greater insight into the renoprotective effects of SGLT2 inhibitors in patients with moderate-to-severe CKD. This review outlines the evidence that SGLT2 inhibitors may prevent the development of CKD and prevent and delay the worsening of CKD in people with T2D at different levels of renal risk. Keywords: Diabetes mellitus, Renal dysfunction, Renal protection, cardiovascular risk Introduction Renal disorders are common in type 2 diabetes (T2D), with approximately 50% of patients developing some degree of renal impairment and an increasing prevalence of both conditions over time [1]. An analysis of the US Diabetes Collaborative Registry revealed that 94% of people with T2D presented with at least one cardiovascular *Correspondence: [email protected] 1 Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy Full list of author information is available at the end of the article
(CV), metabolic, or renal comorbidity, including 20% with chronic kidney disease (CKD) [2]. The risk of renal disorders in T2D includes the development of multiple phenotypes of organ damage, often overlapping and ultimately progressing, similar to what occurs for cardi
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