SGLT-2 inhibitors in chronic kidney disease: state of the art

Abstract

All patients with chronic kidney disease (CKD) require treatment to reduce the risk of cardiovascular events and to prevent progression of renal failure. ACE inhibitors and angiotensin receptor blockers are widely used for cardio- and nephroprotection in patients with CKD. Sodium glucose cotransporter type 2 (SGLT-2) inhibitors show significant prospects for reducing morbidity and mortality in this population. SGLT-2 inhibitors have been developed for treatment of patients with type 2 diabetes mellitus. However, evidence from multiple randomized clinical trials suggested that these drugs have cardio- and nephroprotective effects in patients with and without diabetes. Despite a wealth of data, SGLT-2 inhibitors remain underused by nephrologists or cardiologists. This is not surprising since new therapies traditionally take decades from research to clinical implementation due to many barriers, including lack of knowledge, concern about drug side effects, lack of decision support, cost, and clinical inertia. The review article presents data from scientific studies on the renoprotective effect of SGLT-2 inhibitors and the mechanisms of this activity in CKD patients.