Prevalence of Admission Hyponatremia in Patients With Diabetes Treated With and Without an SGLT2 inhibitor

Monnerat, Sophie; Atila, Cihan; Refardt, Julie

doi:10.1210/jendso/bvad011

Cited by 4 publications

(5 citation statements)

References 45 publications

(63 reference statements)

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“…Recently, two randomized, double-blind, placebo-controlled trials provided evidence that empagliflozin is an effective treatment in both hospitalized patients with syndrome of inappropriate antidiuresis (SIAD) and outpatients with chronic SIAD [ 89 , 90 ]. Both euvolemic and hypervolemic hyponatremia primarily result from arginine vasopressin (AVP)–mediated free water retention, which is represented by decreased free water clearance [ 91 , 92 ]. Fluid restriction or vasopressin V2 receptor antagonists are typically applied to treat hyponatremia [ 91 ].…”

Section: Effects Of Sglt2 Inhibhitor On Tubular Reabsorption In Dista...mentioning

confidence: 99%

“…Both euvolemic and hypervolemic hyponatremia primarily result from arginine vasopressin (AVP)–mediated free water retention, which is represented by decreased free water clearance [ 91 , 92 ]. Fluid restriction or vasopressin V2 receptor antagonists are typically applied to treat hyponatremia [ 91 ]. However, fluid restriction has limited efficacy, and vasopressin V2 receptor antagonists, called vaptans, may overcorrect serum Na + [ 91 , 92 ].…”

Section: Effects Of Sglt2 Inhibhitor On Tubular Reabsorption In Dista...mentioning

confidence: 99%

“…Fluid restriction or vasopressin V2 receptor antagonists are typically applied to treat hyponatremia [ 91 ]. However, fluid restriction has limited efficacy, and vasopressin V2 receptor antagonists, called vaptans, may overcorrect serum Na + [ 91 , 92 ]. SGLT2 inhibitors increase glucosuria, which leads to osmotic diuresis, and this may result in increased excretion of free water [ 92 ].…”

Section: Effects Of Sglt2 Inhibhitor On Tubular Reabsorption In Dista...mentioning

confidence: 99%

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

2023

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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.

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Section: Effects Of Sglt2 Inhibhitor On Tubular Reabsorption In Dista...mentioning

confidence: 99%

Section: Effects Of Sglt2 Inhibhitor On Tubular Reabsorption In Dista...mentioning

confidence: 99%

Section: Effects Of Sglt2 Inhibhitor On Tubular Reabsorption In Dista...mentioning

confidence: 99%

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

2023

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“…Finally, the inhibition of sodium–hydrogen exchange via a direct cardiac effect can lead to a reduction in cardiac remodeling [ 29 , 32 ]. Regarding plasma Na + and K + levels, recent evidence suggests that treatment with SGLT2i does not prevent hyponatremia [ 33 ], whereas it reduces the risk of hyperkalemia but has a minimal effect on decreasing serum K + [ 34 ].…”

Section: Pharmaceutical Agents In Heart Failure Patients and Their Ef...mentioning

confidence: 99%

Medical Treatment in Heart Failure with Reduced Ejection Fraction: A Proposed Algorithm Based on the Patient’s Electrolytes and Congestion Status

et al. 2023

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In heart failure (HF) with reduced ejection fraction (HFrEF), four classes of drugs (β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and the most recent Sodium–Glucose Co-Transporters 2 Inhibitors) have demonstrated positive results in randomized controlled trials (RCTs). Nevertheless, the latest RCTs are not proper for comparison since they were carried out at various times with dissimilar background therapies and the patients enrolled did not have the same characteristics. The difficulty of extrapolating from these trials and proposing a common framework appropriate for all cases is thus obvious. Despite the fact that these four agents are now the fundamental pillars of HFrEF treatment, the built-up algorithm of initiation and titration is a matter of debate. Electrolyte disturbances are common in HFrEF patients and can be attributed to several factors, such as the use of diuretics, renal impairment, and neurohormonal activation. We have identified several HFrEF phenotypes according to their sodium (Na+) and potassium (K+) status in a “real world” setting and suggest an algorithm on how to introduce the most appropriate drug and set up therapy based on the patients’ electrolytes and the existence of congestion.

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“…Hiponatremia przy przyjęciu do szpitala wiąże się ze zwiększoną śmiertelnością wewnątrzszpitalną. Ponadto koreluje ze zwiększonym ryzykiem przyjęcia na oddział intensywnej terapii i prawdopodobieństwem wentylacji mechanicznej, dłuższym pobytem w szpitalu, a co za tym idzie wyższymi kosztami pobytu w szpitalu [8,9].…”

Section: Materiały I Metodyunclassified

Analysis of the relationship between serum sodium concentration and laboratory parameters in diabetic patients

Aab,

Zarańska,

Kędra

et al. 2023

J Educ Health Sport

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Introduction: Diabetes is a chronic civilization disease that is associated with numerous complications and disturbances in laboratory parameters. One of the observed changes in laboratory studies of individuals suffering from diabetes is a significantly low level of sodium. Aim of study: The aim of study was to compare natremia with selected blood parameters determined on admission to hospital, and then to find correlation, if any, between those parameters. Materials and methods: We retrospectively reviewed the medical records of 169 patients with diagnosed type 2 diabetes and the average age of 72.43±11.62 years. We tested the correlation between natremia and: total, LDL and HDL cholesterol; creatinine; potassium; calcium; eGFRCKD-EPI and alanine aminotransferase levels in the patients. Statistical analysis was run on STATISTICA 13. The nonparametric Mann-Whitney, Spearmans’ rank correlation and the Shapiro-Wilk tests were used to analyse factors affecting laboratory test results for the patients, perform correlation analyses and check the conformity with normal distribution, respectively. Research results: A positive correlation was revealed between LDL level and natremia (p = 0.023), as well as between natremia and chloride ion concentration (p < 0.001) in the patients’ blood. No correlation was found between natremia and sex, age, eGFRCKD-EPI, alanine aminotransferase, HDL cholesterol, triglycerides, creatinine, as well as calcium and potassium concentrations. Conclusions: Statistically significant correlations were found exclusively between LDL level and natremia, and between chloride and sodium concentrations. High LDL level was correlated with high natremia, which requires further research due to the scant literature. The sodium, potassium and chloride concentrations are known to be interconnected by the need to ensure the electrolyte balance, as seen in the Gamble diagram. The remaining parameters were not statistically significant.

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Prevalence of Admission Hyponatremia in Patients With Diabetes Treated With and Without an SGLT2 inhibitor

Cited by 4 publications

References 45 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

Medical Treatment in Heart Failure with Reduced Ejection Fraction: A Proposed Algorithm Based on the Patient’s Electrolytes and Congestion Status

Analysis of the relationship between serum sodium concentration and laboratory parameters in diabetic patients

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