Acting on the Latest SGLT2i Evidence to Treat CKD Patients in Primary Care

Abstract

The prevalence of Chronic Kidney Disease (CKD) in Singapore is increasing due to an ageing Singapore population and the increasing prevalence of risk factors such as hypertension and diabetes. Screening using serum creatinine and urine albumin to creatinine ratio (UACR) aids in the detection and classification of CKD. This allows interventions for the retardation of kidney function decline and the prevention of the complications of CKD, which includes endstage kidney disease (ESKD), anaemia, mineral bone disorder, and mortality. Besides the optimal use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) in both diabetic and non-diabetic CKD, sodiumglucose cotransporter type 2 inhibitors (SGLT2i) have been identified to retard CKD, prevent ESKD, and mortality. More recent studies suggest that regardless of the degree of albuminuria or glycated haemoglobin, SGLT2i improves the outcomes of CKD patients. Moreover, SGLT2i can be initiated with an estimated glomerular filtration rate as low as 20 mL per minute per 1.73 m 2 body surface area. As nephron loss is irreversible, aggressive control of risk factors to target goals and using kidney-protective medications such as ACE-I, ARB, and SGLT2i are crucial in the remission of early CKD.