Glomerular filtration rate as a kidney outcome of diabetic kidney disease: a focus on new antidiabetic drugs

Abstract

Diabetes has reached epidemic proportions, both in Korea and worldwide and is associated with an increased risk of chronic kidney disease and kidney failure (KF). The natural course of kidney function among people with diabetes (especially type 2 diabetes) may be complex in real-world situations. Strong evidence from observational data and clinical trials has demonstrated a consistent association between decreased estimated glomerular filtration rate (eGFR) and subsequent development of hard renal endpoints (such as KF or renal death). The disadvantage of hard renal endpoints is that they require a long follow-up duration. In addition, there are many patients with diabetes whose renal function declines without the appearance of albuminuria, measurement of the eGFR is emphasized. Many studies have used GFR-related parameters, such as its change, decline, or slope, as clinical endpoints for kidney disease progression. In this respect, understanding the trends in GFR changes could be crucial for developing clinical management strategies for the prevention of diabetic complications. This review focuses on the clinical implication of the eGFR-related parameters that have been used so far in diabetic kidney disease. We also discuss the use of recently developed new antidiabetic drugs for kidney protection, with a focus on the GFR as clinical endpoints.

Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics

“…In addition to their glucose-lowering effect, SGLT2 inhibitors have beneficial effects on cardiovascular and renal disease risk factors, such as weight loss and blood pressure reduction [19,20]. Indeed, cardiovascular and dedicated renal outcome trials of SGLT2 inhibitors have demonstrated that these drugs inhibit and delay the development and progression of cardiovascular and renal diseases [21][22][23].…”

A new journey to predict the prognosis of diabetic kidney disease

“…Diabetic kidney disease (DKD), characterized by a gradually decreasing glomerular filtration rate (GFR) with or without albuminuria, has been considered the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide [ 1 ]. In patients with type 1 diabetes mellitus (DM) and type 2 DM (T2DM), the prevalence of DKD is 30% and 40%, respectively [ 2 ].…”

“…In patients with type 1 diabetes mellitus (DM) and type 2 DM (T2DM), the prevalence of DKD is 30% and 40%, respectively [ 2 ]. Because DKD is highly prevalent in patients with DM, it increases the risk of CKD progression along with cardiovascular morbidity and mortality, making early detection and prediction of the prognosis for DKD important [ 1 ].…”

“…Despite unneglectable limitations, the most commonly used prognostic factors of DKD are estimated GFR (eGFR) and albuminuria [ 1 ]. As DKD progresses, the number of nephrons decreases, and the single-nephron GFRs of the remaining nephrons increase by compensatory mechanisms.…”