Update on the impact of sodium-glucose cotransporter inhibitors in diabetic kidney disease progression

• Type: Thesis
• Date: 2020-05-28

Authors

Ana Carolina Cruz Afonso Romano (Author) FMUP

Thesis

Update on the impact of sodium-glucose cotransporter inhibitors in diabetic kidney disease progression

Master's Degree

Dissertation

Scientific classification

FOS: Medical and Health sciences

Associated Institutions

fmup

Other information

DOI: 10.34626/60zk-pd71

Resumo (PT): Introdução: A doença renal diabética permanece como uma das principais causas de doença renal terminal. Nos últimos anos, os inibidores do cotransportador de sódio-glucose 2 (SGLT2i) emergiram como classe promissora ao mostrar efeitos nefroprotetores notáveis. Esta revisão destaca os resultados dos ensaios clínicos recentes, analisa os múltiplos mecanismos envolvidos e aborda os possíveis efeitos adversos. Métodos: A revisão bibliográfica resultou da pesquisa de artigos publicados na PubMed/Medline (palavras-chave: sodium-glucose cotransporter inhibitors, diabetic kidney disease, diabetic nephropaty and progression) e da pesquisa de ensaios clínicos realizados recentemente que reportaram efeitos dos SGLT2i na progressão da doença renal diabética. Resultados e Discussão: Ensaios clínicos recentes sugeriram que os SGLT2i diminuem o risco de progressão da doença renal diabética. Em relação aos resultados clínicos, o estudo “Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes” (EMPA-REG OUTCOME), “CANagliflozin cardioVascular Assessment Study” (CANVAS) e o “Dapagliflozin Effect on CardiovascuLAR Events” (DECLARE-TIMI 58) mostraram uma redução de 45% no risco de agravamento da função renal, doença renal terminal ou morte por causas renais. A nefroproteção foi consistente em todos os resultados individuais. O estudo dedicado aos resultados clínicos renais “Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation” (CREDENCE) mostrou um risco 34% inferior de desenvolver o mesmo conjunto de eventos. Conclusão: Há forte evidência que sugere que os SGLT2i reduzem a progressão da nefropatia em indivíduos com diabetes tipo 2. Os dados apresentados nesta revisão apoiam o uso desta classe farmacológica, de forma a atrasar a progressão da doença renal diabética.

Abstract (EN): Introduction: Diabetic kidney disease (DKD) stands as a major cause of end-stage renal disease (ESRD). Sodium-glucose co-transporter 2 inhibitors (SGLT2i) emerged in the last years as a promising class by showing remarkable nephroprotective effects. This review focuses on the nephroprotective effects suggested in recent clinical trials, analyzes the pleiotropic mechanisms involved and discusses the possible adverse effects. Methods: This bibliographic review was based on a research in PubMed/Medline (MeSH terms: sodium-glucose cotransporter inhibitors, diabetic kidney disease, diabetic nephropathy and progression) and the research for recently conducted clinical trials that reported effects of SGLT2i on diabetic kidney disease progression. Results and Discussion: Recent clinical studies have suggested that SGLT2i class decreases the risk of diabetic kidney disease progression. Regarding long-term clinical outcomes, Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME), CANagliflozin cardioVascular Assessment Study (CANVAS) and Dapagliflozin Effect on CardiovascuLAR Events (DECLARE-TIMI 58) showed a 45% risk reduction in worsening of renal function , end-stage renal disease or death from renal causes. Renoprotection was also consistent across all individual outcomes. Dedicated kidney outcome trial Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) showed a 34% lower risk of developing the same renal endpoint. Conclusion: There is strong evidence suggesting that SGLT2i reduces nephropathy progression in individuals with type 2 diabetes. The data presented in this review supports the use of this pharmacological class in order to delay diabetic kidney disease progression.

Language: English

No. of pages: 39