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 PB., Sarafidis P., Ekart R., Ferro CJ., Balafa O., Fernandez-Fernandez B., Herrington WG., Rossignol P., Del Vecchio L., Valdivielso JM., Mallamaci F., Ortiz A., Nistor I., Cozzolino M.

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.

DOI

10.1093/ndt/gfad112

Type

Journal article

Journal

Nephrol Dial Transplant

Publication Date

31/10/2023

Volume

38

Pages

2444 - 2455

Keywords

cardiorenal syndrome, cardiovascular, chronic renal failure, diabetic kidney disease, heart failure, Humans, Sodium-Glucose Transporter 2 Inhibitors, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Renal Dialysis, Renal Insufficiency, Chronic, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Heart Failure

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