The Why and How of SGLT2 Inhibitors in CKD A Practical Approach
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Keywords
SGLT2 inhibitor, chronic kidney disease, cardioprotective, euglycemic dka
Abstract
Abstract
There is growing evidence for the cardiorenal protective benefits of sodium-glucose co-transport 2 (SGLT2) inhibitors for diabetic and non-diabetic-related chronic kidney disease (CKD) patients. As many clinical guidelines increasingly incorporate SGLT2 inhibitors, we sought to review: the rationale and background for their use in CKD, monitoring after initiation, how to handle concomitant diuretics and diabetic medication, therapeutic role and side effects, preventing adverse events, and the use of SGLT2 inhibitors with other novel agents for slowing the trajectory kidney function decline. We hope to overcome prescriber hesitancy and uncertainty through a case-based discussion and increase prescription rates in appropriate patients to benefit more from this therapy.
Résumé
Il existe de plus en plus de données probantes à l’appui des avantages liés à la protection cardiorénale des inhibiteurs du cotransporteur sodium-glucose de type 2 (SGLT2) chez les patients atteints d’insuffisance rénale chronique (IRC) liée ou non au diabète. Comme de nombreuses lignes directrices cliniques intègrent de plus en plus les inhibiteurs du SGLT2, nous avons cherché à faire le point sur : la justification et le con-texte de leur utilisation en IRC, la surveillance après l’amorce du traitement, la façon de gérer la prise con-comitante de diurétiques et de médicaments contre le diabète, le rôle thérapeutique et les effets secondaires, la prévention des évènements indésirables et l’utilisation des inhibiteurs du SGLT2 avec d’autres nouveaux agents pour ralentir la trajectoire du déclin de la fonction rénale. Par l’intermédiaire d’une analyse fondée sur des cas concrets, nous espérons surmonter les réticences et l’incertitude des prescripteurs et augmenter le taux de prescription pour les patients chez qui le traitement est approprié de sorte que davantage de patients puissent tirer profit de ce traitement.
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Megan Borkum, University of British Columbia, Vancouver, BC, Canada
Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
Adeera Levin, University of British Columbia, Vancouver
Division of Nephrology, University of British Columbia, Vancouver, BC, Canada