Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors

Chan, Anthony T P; Tang, Sydney C.W.

doi:10.23876/j.krcp.21.285

Cited by 5 publications

(4 citation statements)

References 92 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Over the last 5 years, numerous advancements emerged in the management of CKD with diabetes [ 94 ]. Notably, SGLT2 inhibitors have become indispensable for the treatment of CKD with or even without diabetes [ 95 ]. In ‘the new era of SGLT2 inhibitors,’ it is likely that almost all CKD patients should be put on SGLT2 inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Intrarenal Mechanisms of Sodium-Glucose Cotransporter-2 Inhibitors on Tubuloglomerular Feedback and Natriuresis

2023

View full text Add to dashboard Cite

When sodium-glucose cotransporter-2 (SGLT2) inhibitors were first introduced a decade ago, no one expected them to have substantial effects beyond their known glucose-lowering effects, until the emergence of evidence of their robust renal and cardiovascular benefits showing that they could attenuate progression of kidney disease, irrespective of diabetes, as well as prevent the development of acute kidney injury. Still, the precise and elaborate mechanisms underlying the major organ protection of SGLT2 inhibitors remain unclear. SGLT2 inhibitors inhibit the reabsorption of sodium and glucose in the proximal tubule of the kidney and then recovers tubuloglomerular feedback, whereby SGLT2 inhibitors reduce glomerular hyperfiltration. This simple demonstration of their beneficial effects has perplexed experts in seeking more plausible and as yet undisclosed explanations for the whole effects of SGLT2 inhibitors, including metabolism reprogramming and the modulation of hypoxia, inflammation, and oxidative stress. Given that the renal benefits of SGLT2 inhibitors in patients with kidney disease but without diabetes were comparable to those seen in patients with diabetes, it may be reasonable to keep the emphasis on their hemodynamic actions. In this context, the aim of the present review is to provide a comprehensive overview of renal hemodynamics in individuals with diabetes who are treated with SGLT2 inhibitors, with a focus on natriuresis associated with the regulation of tubuloglomerular feedback and potential aquaresis. Throughout the discussion of alterations in renal sodium and water transports, particular attention will be given to the potential enhancement of adenosine and its receptors following SGLT2 inhibition.

show abstract

Section: Discussionmentioning

confidence: 99%

Intrarenal Mechanisms of Sodium-Glucose Cotransporter-2 Inhibitors on Tubuloglomerular Feedback and Natriuresis

2023

View full text Add to dashboard Cite

show abstract

“…Table 2 presents additional information regarding the effects of each of the four drugs on weight loss, blood pressure, and contraindications for each of the four drugs. Other promising drugs, such as the sodium-glucose cotransporter 2 inhibitor, setmelanotide, and other GLP-1 agonists, are under development [ 11 , 90 , 95 ]. Semaglutide, which is another GLP-1 receptor agonist, at a 2.4-mg subcutaneous injection (higher dose formulation of semaglutide, once-weekly dose; Wegovy, Novo Nordisk), was approved by the U.S. Food and Drug Administration for weight loss.…”

Section: How To Manage Obesity-related Hypertensionmentioning

confidence: 99%

Obesity-related hypertension and chronic kidney disease: from evaluation to management

Jung

Ihm

2023

Kidney Res Clin Pract

View full text Add to dashboard Cite

With the recent obesity pandemic, obesity-related hypertension and its complications (e.g., heart failure, coronary disease, and chronic kidney disease [CKD]) are gaining attention in clinical and research fields. Obesity-related hypertension frequently precedes the onset of CKD and aggravates its progression. In this review, we discuss the role of visceral fat in the pathophysiology of obesity-related hypertension and the potential therapeutic strategies for its prevention and management. Various factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and inflammatory pathways, are intricately involved in the pathogenesis of obesity-related hypertension. These factors individually and jointly contribute to the development of hypertension (usually sodium-sensitive or resistant hypertension) and, ultimately, to the progression of CKD. From a clinical standpoint, a decline in renal function in advanced CKD further makes blood pressure control challenging since only a few options are available for blood pressure-lowering medications. Proactive lifestyle modification, pharmacological treatment for obesity, and bariatric surgery can be considered for obesity control and management. Furthermore, intensive blood pressure control is required to prevent and halt the development and progression of CKD.

show abstract

“…Even after patients with diabetes were excluded from this study cohort, low blood glucose was associated with a rapid eGFR decline. Although, the exact mechanism between low blood glucose and renal dysfunction is not well understood, some potential relationships may be proposed based on previous studies [34][35][36][37][38]. For example, a preclinical study has demonstrated that hypoglycemia can cause elevated nonesterified fatty acid in adipose tissue, which is subsequently associated with kidney damage [34].…”

Section: Plos Onementioning

confidence: 99%

“…The kidney has gluconeogenesis capability and contributes to 20% glycogen production [36]. In the proximal segment of the tubular nephron, SGLT1 and SGLT2 provide highly efficient glucose reabsorption [36][37][38]. In this context, hypoglycemia may be an early sign of kidney dysfunction.…”

Section: Plos Onementioning

confidence: 99%

Risk factors associated with the discordance in kidney function decline rate in identical twins

et al. 2023

View full text Add to dashboard Cite

Background The rate of kidney function decline is different for each individual regardless of any difference in the medical histories. This study set out to identify the risk factors for high discordance in kidney function decline in an identical twin cohort. Methods This study included 333 identical twins from the Korean Genome and Epidemiology Study who were categorized into two groups according to the estimated glomerular filtration rate (eGFR) decline: the slow and rapid progressor groups. The mean differences of variables were compared between the two groups. We calculated the difference in the annual eGFR change between twins and analyzed the risk factors associated with high discordance in twins who had > 5 mL/min/1.73 m2 /yr of the intra-twin difference in the annual eGFR decline. Identical twins with diabetes and baseline eGFR < 60 mL/min/1.73 m2 were excluded. Results The high discordance twins showed significant differences in body mass index; waist-to-hip ratio; total body fat percentage; and levels of blood hemoglobin, serum fasting glucose, albumin, triglyceride, and uric acid; however, there were no differences in low discordance twins. Multivariable logistic regression showed that blood hemoglobin level is the only significant factor associated with high discordance of eGFR decline in twins. Conclusions Blood hemoglobin level may play a role in the individual differences in kidney function decline.

show abstract

Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors

Cited by 5 publications

References 92 publications

Intrarenal Mechanisms of Sodium-Glucose Cotransporter-2 Inhibitors on Tubuloglomerular Feedback and Natriuresis

Intrarenal Mechanisms of Sodium-Glucose Cotransporter-2 Inhibitors on Tubuloglomerular Feedback and Natriuresis

Obesity-related hypertension and chronic kidney disease: from evaluation to management

Risk factors associated with the discordance in kidney function decline rate in identical twins

Contact Info

Product

Resources

About