Is There a Role for SGLT2 Inhibitors in Patients with End-Stage Kidney Disease?

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Current Hypertension Reports Pub Date : 2024-12-01 Epub Date: 2024-06-24 DOI:10.1007/s11906-024-01314-3
Rehma Siddiqui, Yoshitsugu Obi, Neville R Dossabhoy, Tariq Shafi
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Abstract

Purpose of review: Chronic kidney disease and end-stage kidney disease (ESKD) are well-established risk factors for cardiovascular disease (CVD), the leading cause of mortality in the dialysis population. Conventional therapies, such as statins, blood pressure control, and renin-angiotensin-aldosterone system blockade, have inadequately addressed this cardiovascular risk, highlighting the unmet need for effective treatment strategies. Sodium-glucose transporter 2 (SGLT2) inhibitors have demonstrated significant renal and cardiovascular benefits among patients with type 2 diabetes, heart failure, or CKD at risk of progression. Unfortunately, efficacy data in dialysis patients is lacking as ESKD was an exclusion criterion for all major clinical trials of SGLT2 inhibitors. This review explores the potential of SGLT2 inhibitors in improving cardiovascular outcomes among patients with ESKD, focusing on their direct cardiac effects.

Recent findings: Recent clinical and preclinical studies have shown promising data for the application of SGLT2 inhibitors to the dialysis population. SGLT2 inhibitors may provide cardiovascular benefits to dialysis patients, not only indirectly by preserving the remaining kidney function and improving anemia but also directly by lowering intracellular sodium and calcium levels, reducing inflammation, regulating autophagy, and alleviating oxidative stress and endoplasmic reticulum stress within cardiomyocytes and endothelial cells. This review examines the current clinical evidence and experimental data supporting the use of SGLT2 inhibitors, discusses its potential safety concerns, and outlines ongoing clinical trials in the dialysis population. Further research is needed to evaluate the safety and effectiveness of SGLT2 inhibitor use among patients with ESKD.

Abstract Image

SGLT2 抑制剂对终末期肾病患者有作用吗?
审查目的:慢性肾脏病和终末期肾脏病(ESKD)是心血管疾病(CVD)的既定风险因素,也是导致透析人群死亡的主要原因。他汀类药物、血压控制和肾素-血管紧张素-醛固酮系统阻断等传统疗法都不足以应对这一心血管风险,这凸显了对有效治疗策略的需求尚未得到满足。钠-葡萄糖转运体 2(SGLT2)抑制剂已在 2 型糖尿病、心力衰竭或有进展风险的慢性肾脏病患者中证明了对肾脏和心血管的显著益处。遗憾的是,由于 ESKD 是所有 SGLT2 抑制剂主要临床试验的排除标准,因此缺乏透析患者的疗效数据。本综述探讨了 SGLT2 抑制剂在改善 ESKD 患者心血管预后方面的潜力,重点关注其对心脏的直接影响:最近的临床和临床前研究显示,SGLT2 抑制剂在透析人群中的应用前景良好。SGLT2 抑制剂可为透析患者带来心血管方面的益处,这不仅是通过保护剩余肾功能和改善贫血而间接实现的,而且还可通过降低细胞内钠和钙水平、减少炎症、调节自噬以及减轻心肌细胞和内皮细胞内的氧化应激和内质网应激而直接实现。本综述探讨了支持使用 SGLT2 抑制剂的现有临床证据和实验数据,讨论了其潜在的安全性问题,并概述了正在透析人群中进行的临床试验。还需要进一步的研究来评估 ESKD 患者使用 SGLT2 抑制剂的安全性和有效性。
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来源期刊
Current Hypertension Reports
Current Hypertension Reports 医学-外周血管病
CiteScore
10.50
自引率
0.00%
发文量
65
审稿时长
6-12 weeks
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of hypertension. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antihypertensive therapies, associated metabolic disorders, and therapeutic trials. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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