Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics
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 o...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Diabetes Association
2022-07-01
|
| Series: | Diabetes & Metabolism Journal |
| Subjects: | |
| Online Access: | http://e-dmj.org/upload/pdf/dmj-2022-0209.pdf |
| _version_ | 1818537114572161024 |
|---|---|
| author | Nam Hoon Kim Nan Hee Kim |
| author_facet | Nam Hoon Kim Nan Hee Kim |
| author_sort | Nam Hoon Kim |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T18:46:35Z |
| format | Article |
| id | doaj.art-140d6c860df2499097f3f58817618266 |
| institution | Directory Open Access Journal |
| issn | 2233-6079 2233-6087 |
| language | English |
| last_indexed | 2024-12-11T18:46:35Z |
| publishDate | 2022-07-01 |
| publisher | Korean Diabetes Association |
| record_format | Article |
| series | Diabetes & Metabolism Journal |
| spelling | doaj.art-140d6c860df2499097f3f588176182662022-12-22T00:54:27ZengKorean Diabetes AssociationDiabetes & Metabolism Journal2233-60792233-60872022-07-0146454355110.4093/dmj.2022.02092686Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal HemodynamicsNam Hoon Kim0Nan Hee Kim1Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, KoreaDiabetic 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.http://e-dmj.org/upload/pdf/dmj-2022-0209.pdfdiabetes mellitushemodynamicsrenal insufficiencysodium-glucose transporter 2 inhibitors |
| spellingShingle | Nam Hoon Kim Nan Hee Kim Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics Diabetes & Metabolism Journal diabetes mellitus hemodynamics renal insufficiency sodium-glucose transporter 2 inhibitors |
| title | Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics |
| title_full | Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics |
| title_fullStr | Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics |
| title_full_unstemmed | Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics |
| title_short | Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics |
| title_sort | renoprotective mechanism of sodium glucose cotransporter 2 inhibitors focusing on renal hemodynamics |
| topic | diabetes mellitus hemodynamics renal insufficiency sodium-glucose transporter 2 inhibitors |
| url | http://e-dmj.org/upload/pdf/dmj-2022-0209.pdf |
| work_keys_str_mv | AT namhoonkim renoprotectivemechanismofsodiumglucosecotransporter2inhibitorsfocusingonrenalhemodynamics AT nanheekim renoprotectivemechanismofsodiumglucosecotransporter2inhibitorsfocusingonrenalhemodynamics |