eGFR Decline after SGLT2 Inhibitor Initiation: The Tortoise and the Hare Reimagined
| Autor: | Jordan Weinstein, Alejandro Meraz-Muñoz, Ron Wald |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
030232 urology & nephrology Context (language use) 030204 cardiovascular system & hematology Placebo 03 medical and health sciences 0302 clinical medicine Internal medicine Medicine Animals Renal Insufficiency Chronic Sodium-Glucose Transporter 2 Inhibitors Ejection fraction business.industry Type 2 Diabetes Mellitus General Medicine medicine.disease Hares Renal glucose reabsorption Turtles Heart failure Cardiology SGLT2 Inhibitor business Perspectives Kidney disease Glomerular Filtration Rate |
| Zdroj: | Kidney360 |
| ISSN: | 2641-7650 |
| Popis: | Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have emerged as an effective class of medications to treat CKD and heart failure. SGLT2is improve cardiovascular outcomes in patients with type 2 diabetes mellitus (1⇓–3) and in those with heart failure with reduced ejection fraction (4⇓⇓–7). Moreover, they have been shown to attenuate kidney disease progression in patients with proteinuric CKD, irrespective of diabetes status (8,9). The rapid uptake of SGLT2is into practice necessitates a careful understanding of their risks. Furthermore, clinicians need to know what to expect when prescribing these agents, including an early decline in eGFR after initiation. We aim to put this observation into context, while providing clinicians with a practical approach to managing this scenario. The suggested mechanism of action of the SGLT2is has previously been described (10). These drugs inhibit sodium and glucose reabsorption in the proximal tubule, leading to increased sodium and chloride delivery to the macula densa. This results in afferent arteriolar vasoconstriction secondary to adenosine-mediated myogenic activation, leading to a reduction in the intraglomerular pressure and the GFR (10). Therefore, it is not surprising that the major SGLT2i outcome trials have reported an early decline in eGFR (around 3–6 ml/min per 1.73 m2) shortly after initiating these drugs compared with placebo controls (5,8,9,11,12). These early declines or dips were typically observed at 2–4 weeks after initiation of the SGLT2i, with subsequent partial recovery of the eGFR curve by week 12, and, ultimately, followed by an attenuation of the slope of eGFR decline compared with placebo controls after 52 weeks (Table 1). View this table: Table 1. Randomized controlled trials reporting an initial dip of eGFR How can we reconcile early dips in eGFR with long-term nephroprotection? Maladaptive glomerular hemodynamics play a central … |
| Databáze: | OpenAIRE |
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