Renal hemodynamic effects of sodium-glucose cotransporter 2 inhibitors in hyperfiltering people with type 1 diabetes and people with type 2 diabetes and normal kidney function

Bommel, Erik J.M. van; Perkins, Bruce A.; Soleymanlou, Nima; Fagan, Nora; Koïtka-Weber, Audrey; Joles, Jaap A.; Cherney, David Z.I.; Raalte, Daniël H. van

doi:10.1016/j.kint.2019.12.021

Cited by 34 publications

(36 citation statements)

References 20 publications

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“…This characteristic eGFR "dip" has been commonly attributed to the effect of proximal tubular natriuresis on tubuloglomerular feedback, leading to reversible intrarenal hemodynamic effects, including afferent vasoconstriction. 1,4 Second, from a mechanistic perspective, physicians and physiologists have been taught to think of medicationrelated afferent arteriolar constriction to be harmful by definition, based on how nonsteroidal anti-inflammatory drugs (NSAIDs) act in the kidney. As described later, SGLT2 inhibitors are clearly not NSAIDs, and drawing parallels between these classes of drugs is both clinically and physiologically incorrect.…”

mentioning

confidence: 99%

We Can Finally Stop Worrying About SGLT2 Inhibitors and Acute Kidney Injury

Sridhar

Cherney

2020

American Journal of Kidney Diseases

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mentioning

confidence: 99%

We Can Finally Stop Worrying About SGLT2 Inhibitors and Acute Kidney Injury

Sridhar

Cherney

2020

American Journal of Kidney Diseases

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“…In rodent models of type 1 diabetes (T1D) and in people with T1D with glomerular hyperfiltration (GFR > 135 mL/min/1.73 m 2 ) this led to vasoconstriction of the preglomerular arteriole and GFR lowering 29‐32 . On the other hand, in people with T2D that were older, similar decreases in GFR were induced by post‐glomerular vasodilatory effects in two separate studies rather than preglomerular vasoconstriction (Figure 1), indicating genuine renal haemodynamic differences between people with T1D and T2D as well as different effects of SGLT2 inhibition 33‐35 . As such, these studies showed a reduction in renal vascular resistance (RVR) and post‐glomerular resistance, while ERPF was not reduced.…”

Section: Nephroprotection By Sglt2 Inhibition: Lowering Of Glomerularmentioning

confidence: 97%

“…When assessing potential interactions with respect to renal haemodynamic actions of different drugs in people with T2D, it is important to understand the actions of each individual drug class, specifically studied in this population, as baseline characteristics strongly drive response to drug therapy 35,38 . In previous literature, many conclusions regarding the renal haemodynamic actions of drug classes have been based on data from animal studies or from human studies comprising different populations, including adults with hypertension or T1D 37 .…”

Section: Renal Haemodynamic Effects Of Sglt2 Inhibition: Interaction mentioning

confidence: 99%

Renal haemodynamic and protective effects of renoactive drugs in type 2 diabetes: Interaction with SGLT2 inhibitors

et al. 2021

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Diabetic kidney disease remains the leading cause of end‐stage kidney disease and a major risk factor for cardiovascular disease. Large cardiovascular outcome trials and dedicated kidney trials have shown that sodium‐glucose cotransporter (SGLT)2 inhibitors reduce cardiovascular morbidity and mortality and attenuate hard renal outcomes in patients with type 2 diabetes (T2D). Underlying mechanisms explaining these renal benefits may be mediated by decreased glomerular hypertension, possibly by vasodilation of the post‐glomerular arteriole. People with T2D often receive several different drugs, some of which could also impact the renal vasculature, and could therefore modify both renal efficacy and safety of SGLT2 inhibition. The most commonly prescribed drugs that could interact with SGLT2 inhibitors on renal haemodynamic function include renin‐angiotensin system inhibitors, calcium channel blockers and diuretics. Herein, we review the effects of these drugs on renal haemodynamic function in people with T2D and focus on studies that measured glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) with gold‐standard techniques. In addition, we posit, based on these observations, potential interactions with SGLT2 inhibitors with an emphasis on efficacy and safety.

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“…The precise mechanisms behind heart and kidney benefits of SGLT2 inhibitors are incompletely understood, though there are likely multiple complementary physiological effects [7,8]. Kidney protective mechanisms of SGLT2 inhibitors are commonly considered according to hemodynamic versus non-hemodynamic actions.…”

Section: Sglt2 Inhibitors Cardiovascular and Kidney Protection In Patients With T2dm Sglt2 Inhibition And Mechanistic Benefitsmentioning

confidence: 99%

Cardiorenal Protection in Diabetic Kidney Disease

et al. 2021

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Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.

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Renal hemodynamic effects of sodium-glucose cotransporter 2 inhibitors in hyperfiltering people with type 1 diabetes and people with type 2 diabetes and normal kidney function

Cited by 34 publications

References 20 publications

We Can Finally Stop Worrying About SGLT2 Inhibitors and Acute Kidney Injury

We Can Finally Stop Worrying About SGLT2 Inhibitors and Acute Kidney Injury

Renal haemodynamic and protective effects of renoactive drugs in type 2 diabetes: Interaction with SGLT2 inhibitors

Cardiorenal Protection in Diabetic Kidney Disease

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