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SGLT2 Inhibitors and Kidneys

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Dr Manisha Sahay, Hyderabad    26 November 2018

  1. Diabetes is the most important contributor to the growing burden of ESRD. About 30-40% of all kidney diseases in India are due to diabetes.
  2. SGLT2i reduce renal glucose reabsorption. SGLT2 receptors are the ideal targets to reduce reabsorption of glucose.
  3. Most current therapies for T2DM have an insulin-dependent mechanism of action. SGLT2i are insulin-independent.
  4. SGLT2i lower intraglomerular pressure.
  5. SGLT2i exercise renoprotection on account of the following effects – Direct effects: Reduce hyperfiltration and Indirect effects: Improve glycemic control; reduce weight; reduce BP; reduce uric acid levels; improve lipid profile; improve metabolic syndrome; reduce inflammation.
  6. Canagliflozin treatment has been shown to have positive effects on the lipid profile.
  7. SGLT2i reduce the burden on proximal renal tubules. They improve renal function, reduce albuminuria and stabilize GFR. SGLT2i therapy causes 10-15% reduction in uric acid levels.
  8. Landmark trials such as CANVAS + CANVAS R, EMPA-REG and DECLARE that included diabetes patients with high CV risk, have shown reduced major adverse kidney events (MAKE) with SGLT2i therapy. SGLT2i are ready for prime time in DKD.

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