Second Opinion SGLT2 Inhibitors and Uric acid.

Abstract

The use of SGLT2 inhibitors have had remarkable success in the management of chronic kidney disease, by both slowing progression and reducing cardiovascular mortality. Among their many actions, SGLT2 inhibitors have also been found to lower serum uric acid, likely by both enhancing urinary excretion and blocking urate production. A recent study by Mayne et al reported that SGLT2 inhibitors lowered uric acid levels in the EMPA-Kidney trial, but did not provide any significant protection from gout nor have effect on kidney outcomes. However, there is increasing evidence that lowering of uric acid by SGLT2 inhibitors in subjects with diabetes or heart failure can reduce acute episodes of gout as well as urate kidney stones. Given the frequency of hyperuricemia and gout in the subject with CKD, we believe that more studies are needed, and that likely there is some benefit in hyperuricemic subjects with CKD.