Emerging Role of Sodium–Glucose Co-Transporter 2 Inhibitors for the Treatment of Chronic Kidney Disease

Abstract

Rey Isidto,1 Romina Danguilan,2 Oscar Naidas,3 Russell Vilanueva,2 Mel-Hatra Arakama,2 Layla Marie Paraiso2 1HealthLink Medical, Surgical, Dental Clinics and Diagnostic Center, Iloilo City, Iloilo, Philippines; 2Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines; 3Department of Adult Nephrology, St. Luke’s Medical Center, Quezon City, Manila, PhilippinesCorrespondence: Rey Isidto, HealthLink Medical, Surgical, Dental Clinics and Diagnostic Center, Iloilo City, Iloilo, Philippines, Tel [phone], Fax [phone], Email [email protected]: Chronic kidney disease is one of the leading causes of morbidity and mortality in the Philippines. It is associated with a growing health burden as many patients progress to end-stage renal disease. Until recently, therapeutic options for the management of chronic kidney disease were limited. Sodium–glucose co-transporter 2 inhibitors offer an alternative therapeutic approach for patients with chronic kidney disease. Several trials have shown renal benefits with sodium–glucose co-transporter 2 inhibitors in patients with cardiovascular disease with and without type 2 diabetes and across a range of estimated glomerular filtration rate levels. In the Philippines, the sodium–glucose co-transporter 2 inhibitors dapagliflozin and canagliflozin are approved for the prevention of new and worsening nephropathy in type 2 diabetes. With emerging treatment options, an urgent need exists for guidance on the management of chronic kidney disease within the Philippines. In this review, we focus on the putative renal-protective mechanisms of sodium–glucose co-transporter 2 inhibitors, including effects on tubuloglomerular feedback, albuminuria, endothelial function, erythropoiesis, uric acid levels, renal oxygen demand, and hypoxia. Furthermore, we discuss the findings of recent large clinical trials using sodium–glucose co-transporter 2 inhibitors in patients with chronic kidney disease and diabetic kidney disease, summarize safety aspects, and outline the practical management of patients with chronic kidney disease in the Philippines.Keywords: chronic renal insufficiency, diabetic nephropathies, safety, sodium-glucose transporter 2 inhibitors

Keywords

• chronic renal insufficiency
• diabetic nephropathies
• safety
• sodium-glucose transporter 2 inhibitors