SGLT2 inhibitors for treatment of chronic kidney disease

Abstract

There are several mechanisms underlying chronic kidney disease progression and they can be categorised in three major pathways: haemodynamic, metabolic, and inflammatory or fibrotic.¹ Sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce glomerular hyperfiltration,¹ improve energy utilisation and mitochondrial function,² and lower inflammatory mediators, resulting in nephroprotective effects in both diabetic as well as non-diabetic patients.³ Although SGLT2 inhibitors are well-tolerated with a low risk of serious adverse effects, patients need to be counselled on expected adverse events such as the increased risk for genital and urinary infections and how to prevent these, as well as the need to withhold SGLT2 inhibitors during periods of acute illness with vomiting and diarrhoea to prevent volume depletion.⁴