Seven suggestions for successful SGLT2i use in glomerular... : Current Opinion in Nephrology and Hypertension (original) (raw)

EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri

Seven suggestions for successful SGLT2i use in glomerular disease - a standalone CKD therapy?

aGlasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK

bInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

Correspondence to Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. Tel: +44 141 3308218; e-mail: [email protected]

Current Opinion in Nephrology and Hypertension 31(3):p 272-277, May 2022. | DOI: 10.1097/MNH.0000000000000786

Abstract

Purpose of review

Recent advances in the world of glomerular diseases have largely focussed on remission induction with immune modulating therapy. It is well recognised that even with the best available treatments, patients with glomerular diseases may have an increased risk of progressive renal and cardiovascular disease.

Recent findings

The arrival of large trials looking at the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD) and diabetes or not has shifted the entire focus of current management and the shift needs to go further. This review summarises the background to these landmark trials and provides practical guidance for implementation of the results in a general nephrology clinic. In sub-group analyses of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) clinical trial, SGLT2i improved renal outcomes in patients with immunoglobulin A (IgA) nephropathy highlighting the potential for this drug class in glomerular disease. We also discuss where the gaps in evidence are and where future trials in glomerular diseases, be they primary or secondary, should be focussed.

Summary

The renal community has never before had evidence of this strength upon which to base recommendations for patients with CKD and we should be grasping it with both hands.