Sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a class of oral medications recognized for their role in managing chronic kidney disease (CKD). These medications were initially developed to help individuals with type 2 diabetes manage blood sugar levels. However, clinical research has demonstrated their benefits in slowing the progression of kidney disease, even in individuals without diabetes. Their expanding use highlights a shift in treatment strategies for CKD.
How SGLT2 Inhibitors Support Kidney Health
SGLT2 inhibitors work by targeting the kidneys’ ability to reabsorb glucose and sodium. Specifically, they block the sodium-glucose cotransporter 2 protein, which is responsible for reabsorbing most filtered glucose back into the bloodstream from the kidneys’ filtering units. This action leads to increased excretion of glucose and sodium in the urine.
The increased delivery of sodium to a specific part of the kidney called the macula densa triggers a natural feedback mechanism. This mechanism, known as tubuloglomerular feedback, causes the small blood vessels leading into the kidney’s filtering units (glomeruli) to constrict. This constriction reduces the pressure within these filtering units, which helps to protect them from damage and slow the decline of kidney function. This pressure reduction is a mechanism for their kidney-protective effects, independent of their blood sugar-lowering actions. SGLT2 inhibitors have also been shown to reduce albuminuria, a marker of kidney damage, and may offer cardiovascular benefits that indirectly support kidney health.
Approved Medications for Kidney Disease
Several SGLT2 inhibitors have received regulatory approval for treating chronic kidney disease, based on robust clinical trial evidence. These approvals often cover a broad range of CKD patients, sometimes regardless of their type 2 diabetes status.
Dapagliflozin, sold under the brand name Farxiga, is approved for adults with CKD at risk of progression, with or without type 2 diabetes. Its approval for CKD was supported by the DAPA-CKD trial, which demonstrated a reduction in the composite outcome of worsening kidney function or death. This trial showed a notable risk reduction across various patient groups, including those without diabetes.
Empagliflozin, known by the brand name Jardiance, is also approved for adults with CKD, regardless of their type 2 diabetes status. The EMPA-KIDNEY trial provided the primary evidence for empagliflozin’s kidney benefits in a diverse CKD population. This trial indicated that empagliflozin reduced the risk of kidney disease progression or cardiovascular death.
Canagliflozin, marketed as Invokana, was one of the first SGLT2 inhibitors to show kidney protection. The CREDENCE trial established its efficacy in reducing kidney failure and cardiovascular events in patients with type 2 diabetes and CKD. This trial specifically enrolled patients with type 2 diabetes and established kidney disease, demonstrating clear benefits in this population.
Important Information for Patients
SGLT2 inhibitors are an advancement in the management of chronic kidney disease. However, these medications are part of a treatment plan and are not a cure for CKD. They work best when integrated into a broader strategy that may include lifestyle modifications and other medications.
Individuals considering or currently taking SGLT2 inhibitors should maintain regular communication with their healthcare provider. A doctor can provide personalized medical advice, monitor kidney function, and assess overall health to ensure the medication is appropriate and effective. Ongoing medical supervision helps optimize treatment and ensure patient safety.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a class of oral medications increasingly recognized for their role in managing chronic kidney disease (CKD). These medications were initially developed to help individuals with type 2 diabetes manage blood sugar levels. However, clinical research has demonstrated their significant benefits in slowing the progression of kidney disease, even in individuals without diabetes. Their expanding use highlights a shift in treatment strategies for CKD.