SGLT2i for evidence based cardiorenal protection in diabetic and non-diabetic chronic kidney disease- a comprehensive review by EURECA-m and ERBP working groups of ERA

Mark, P. B. et al. (2023) SGLT2i for evidence based cardiorenal protection in diabetic and non-diabetic chronic kidney disease- a comprehensive review by EURECA-m and ERBP working groups of ERA. Nephrology Dialysis Transplantation, (doi: 10.1093/ndt/gfad112) (PMID:37230946) (Early Online Publication)

Abstract

Chronic kidney disease (CKD) is a major public health issue affecting an estimated 850 million people globally. The leading causes of CKD is diabetes and hypertension, which together account for >50% of patients with end-stage kidney disease. Progressive CKD leads to the requirement for kidney replacement therapy with transplantation or dialysis. In addition, CKD, is a risk factor for premature cardiovascular disease, particularly from structural heart disease and heart failure (HF). Until 2015, the mainstay of treatment to slow progression of both diabetic and many non-diabetic kidney diseases was blood pressure control and renin-angiotensin system inhibition; however, neither angiotensin-converting enzyme inhibitors (ACEIs) nor angiotensin receptor blockers (ARBs) reduced cardiovascular events and mortality in major trials in CKD. The emergence of cardiovascular and renal benefits observed with sodium-glucose cotransporter-2 inhibitors (SGLT2i) from clinical trials of their use as anti-hyperglycaemic agents has led to a revolution in cardiorenal protection for patients with diabetes. Subsequent clinical trials, notably DAPA-HF, EMPEROR, CREDENCE, DAPA-CKD and EMPA-KIDNEY have demonstrated their benefits in reducing risk of HF and progression to kidney failure in patients with HF and/or CKD. The cardiorenal benefits—on a relative scale—appear similar in patients with or without diabetes. Specialty societies’ guidelines are continually adapting as trial data emerges to support increasingly wide use of SGLT2i. This consensus paper from EURECA-m and ERBP highlights the latest evidence and summarizes the guidelines for use of SGLT2i for cardiorenal protection focusing on benefits observed relevant to people with CKD.

• Item Type: Articles
• Additional Information: A.O. and B.F.F.’s research is supported by FIS/Fondos FEDER (PI18/01366, PI19/00588, PI19/00815, PI21/00251, PI20/00744), ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, Sociedad Madrileña de Nefrología (SOMANE), FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Instituto de Salud Carlos III (ISCIII) RICORS programme to RICORS2040 (RD21/0005/0001) funded by European Union—NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR) and SPACKDc PMP21/00109, FEDER funds.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mark, Professor Patrick
• Authors: Mark, P. B., Sarafidis, P., Ekart, R., Ferro, C. J., Balafa, O., Fernandez-Fernandez, B., Herrington, W. G., Rossignol, P., Del Vecchio, L., Valdivielso, J. M., Mallamaci, F., Ortiz, A., Nistor, I., and Cozzolino, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Nephrology Dialysis Transplantation
• Publisher: Oxford University Press
• ISSN: 0931-0509
• ISSN (Online): 1460-2385
• Published Online: 25 May 2023
• Copyright Holders: Copyright © The Author(s) 2023.
• First Published: First published in Nephrology Dialysis Transplantation 2023
• Publisher Policy: Reproduced under a Creative Commons license