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Review
. 2020 Jun 24:7:2054358120935701.
doi: 10.1177/2054358120935701. eCollection 2020.

Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review

Lisa Dubrofsky  1 , Anand Srivastava  2 , David Z Cherney  3   4   5   6
Affiliations
Review

Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review

Lisa Dubrofsky et al. Can J Kidney Health Dis. .

Abstract
in English, French

Purpose of the review: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended for eligible patients with type 2 diabetes for the secondary prevention of adverse cardiovascular and kidney disease outcomes. Patients with type 2 diabetes and albuminuric chronic kidney disease, a history of atherosclerotic cardiovascular disease, and/or heart failure with reduced ejection fraction should be assessed for the use of these therapies.

Sources of information: The sources include published clinical trials with SGLT2is, with a focus on cardiovascular safety studies and kidney protection trials.

Methods: Information was gathered via a review of relevant literature and clinical practice guidelines, incorporated with real-life clinical experience.

Key findings: Clinicians prescribing these agents must be familiar with the benefits of SGLT2is on cardiovascular and renal endpoints, and with adverse effects of SGLT2is, including mycotic genital infections and diabetic ketoacidosis. Primary care physicians and specialists should know how to adjust antihypertensive, antiglycemic, and diuretic agents. With the results of completed cardiovascular outcome trials and the Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy trial, nephrologists specifically have a unique opportunity to impact the safe, effective, and equitable implementation of SGLT2is into clinical practice.

Limitations: Further work is needed in specific patient subgroups, including patients with chronic kidney disease stages IV and V, patients with kidney disease but lower levels of albuminuria, and in patients without diabetes.

Justification: Les inhibiteurs du co-transporteur sodium-glucose de type 2 (iSGLT2) sont recommandés pour la prévention secondaire des effets indésirables de nature cardiovasculaire ou rénale chez les patients diabétiques de type 2 qui sont admissibles. Les patients diabétiques de type 2 en insuffisance rénale chronique albuminurique et ayant des antécédents de maladie cardiovasculaire athérosclérotique et/ou d’insuffisance cardiaque avec fraction d’éjection réduite devraient être évalués pour l’utilisation de ces traitements.

Sources: Les essais cliniques publiés portant sur les iSGLT2, avec une attention particulière pour les études traitant de tolérance cardiovasculaire et de protection rénale.

Méthodologie: L’information a été recueillie par l’entremise d’une revue de la littérature pertinente et des guides de pratique clinique, intégrés à l’expérience clinique réelle.

Principaux résultats: Les médecins qui prescrivent des iSGLT2 doivent connaître les bienfaits de ces agents sur les résultats cardiovasculaires et rénaux, tout comme leurs effets indésirables, notamment les infections mycosiques de l’appareil génital et l’acidocétose diabétique. Les spécialistes et les médecins de première ligne doivent être en mesure d’ajuster la posologie des agents antihypertenseurs, des diurétiques et des médicaments contrôlant la glycémie. Grâce aux résultats d’essais portant sur les résultats cardiovasculaires et des conclusions de l’essai CREDENCE (Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy), les néphrologues ont une occasion unique d’influer sur une mise œuvre sûre, efficace et équitable des iSGLT2 dans la pratique clinique.

Limites: Des études supplémentaires portant sur des sous-groupes particuliers de patients sont nécessaires, notamment sur des sujets atteints d’insuffisance rénale chronique de stade IV et V, des patients atteints de néphropathie avec de faibles niveaux d’albuminurie et des sujets non-diabétiques.

Keywords: SGLT2-inhibitors; chronic kidney disease; diabetic kidney disease; secondary prevention; sodium-glucose cotransporter-2 inhibitors; type 2 diabetes.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.S. received honoraria from Horizon Pharma, PLC, and AstraZeneca and consulting fees from CVS Caremark. D.Z.C has received honoraria from Boehringer Ingelheim-Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi-Tanabe, Abbvie, Janssen, Bayer, Prometic, BMS, and Novo-Nordisk and has received operational funding for clinical trials from Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca, and Novo-Nordisk. The other authors have no disclosures.

Figures

Figure 1.
Figure 1.
Proposed algorithm for SGLT2i initiation. Note. Check electrolytes, creatinine after initiation of treatment according to local guidelines/practice. SGLT2i = sodium-glucose cotransporter-2 inhibitor; T2D = type 2 diabetes; eGFR= estimated glomerular filtration rate; SU = sulfonylurea; ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker. aAlso consider following guidance around adjustment of insulin and SU therapies, diuretics, and antihypertensives prior to initiation of therapies.
See this image and copyright information in PMC

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