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Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics.
- Source :
-
Diabetes & metabolism journal [Diabetes Metab J] 2022 Jul; Vol. 46 (4), pp. 543-551. Date of Electronic Publication: 2022 Jul 27. - Publication Year :
- 2022
-
Abstract
- Diabetic kidney disease (DKD) is a prevalent renal complication of diabetes mellitus that ultimately develops into end-stage kidney disease (ESKD) when not managed appropriately. Substantial risk of ESKD remains even with intensive management of hyperglycemia and risk factors of DKD and timely use of renin-angiotensin-aldosterone inhibitors. Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce hyperglycemia primarily by inhibiting glucose and sodium reabsorption in the renal proximal tubule. Currently, their effects expand to prevent or delay cardiovascular and renal adverse events, even in those without diabetes. In dedicated renal outcome trials, SGLT2 inhibitors significantly reduced the risk of composite renal adverse events, including the development of ESKD or renal replacement therapy, which led to the positioning of SGLT2 inhibitors as the mainstay of chronic kidney disease management. Multiple mechanisms of action of SGLT2 inhibitors, including hemodynamic, metabolic, and anti-inflammatory effects, have been proposed. Restoration of tubuloglomerular feedback is a plausible explanation for the alteration in renal hemodynamics induced by SGLT2 inhibition and for the associated renal benefit. This review discusses the clinical rationale and mechanism related to the protection SGLT2 inhibitors exert on the kidney, focusing on renal hemodynamic effects.
- Subjects :
- Glucose metabolism
Hemodynamics
Humans
Kidney metabolism
Sodium metabolism
Sodium pharmacology
Sodium therapeutic use
Sodium-Glucose Transporter 2 metabolism
Sodium-Glucose Transporter 2 pharmacology
Sodium-Glucose Transporter 2 therapeutic use
Diabetes Mellitus, Type 2 complications
Hyperglycemia drug therapy
Kidney Failure, Chronic complications
Sodium-Glucose Transporter 2 Inhibitors pharmacology
Sodium-Glucose Transporter 2 Inhibitors therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 2233-6087
- Volume :
- 46
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Diabetes & metabolism journal
- Publication Type :
- Academic Journal
- Accession number :
- 35929172
- Full Text :
- https://doi.org/10.4093/dmj.2022.0209