PMID- 33121838 OWN - NLM STAT- MEDLINE DCOM- 20210204 LR - 20210204 IS - 1523-6838 (Electronic) IS - 0272-6386 (Linking) VI - 77 IP - 1 DP - 2021 Jan TI - SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. PG - 94-109 LID - S0272-6386(20)30934-3 [pii] LID - 10.1053/j.ajkd.2020.08.003 [doi] AB - Diabetes is the most frequent cause of chronic kidney disease (CKD), leading to nearly half of all cases of kidney failure requiring replacement therapy. The principal cause of death among patients with diabetes and CKD is cardiovascular disease (CVD). Sodium/glucose cotransporter 2 (SGLT2) inhibitors were developed to lower blood glucose levels by inhibiting glucose reabsorption in the proximal tubule. In clinical trials designed to demonstrate the CVD safety of SGLT2 inhibitors in type 2 diabetes mellitus (T2DM), consistent reductions in risks for secondary kidney disease end points (albuminuria and a composite of serum creatinine doubling or 40% estimated glomerular filtration rate decline, kidney failure, or death), along with reductions in CVD events, were observed. In patients with CKD, the kidney and CVD benefits of canagliflozin were established by the CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial in patients with T2DM, urinary albumin-creatinine ratio>300mg/g, and estimated glomerular filtration rate of 30 to<90mL/min/1.73m(2). To clarify and support the role of SGLT2 inhibitors for treatment of T2DM and CKD, the National Kidney Foundation convened a scientific workshop with an international panel of more than 80 experts. They discussed the current state of knowledge and unanswered questions to propose therapeutic approaches and delineate future research. SGLT2 inhibitors improve glomerular hemodynamic function and are thought to ameliorate other local and systemic mechanisms involved in the pathogenesis of CKD and CVD. SGLT2 inhibitors should be used when possible by people with T2DM to reduce risks for CKD and CVD in alignment with the clinical trial entry criteria. Important risks of SGLT2 inhibitors include euglycemic ketoacidosis, genital mycotic infections, and volume depletion. Careful consideration should be given to the balance of benefits and harms of SGLT2 inhibitors and risk mitigation strategies. Effective implementation strategies are needed to achieve widespread use of these life-saving medications. CI - Copyright (c) 2020 The National Kidney Foundation, Inc and American Diabetes Association. Published by Elsevier Inc. All rights reserved. FAU - Tuttle, Katherine R AU - Tuttle KR AD - Providence Health Care and University of Washington School of Medicine, Spokane, WA. Electronic address: katherine.tuttle@providence.org. FAU - Brosius, Frank C 3rd AU - Brosius FC 3rd AD - University of Arizona College of Medicine, Tucson, AZ. FAU - Cavender, Matthew A AU - Cavender MA AD - University of North Carolina School of Medicine, Chapel Hill, NC. FAU - Fioretto, Paola AU - Fioretto P AD - Department of Medicine, University of Padua, Italy. FAU - Fowler, Kevin J AU - Fowler KJ AD - The Voice of the Patient, Inc, Elmhurst, IL. FAU - Heerspink, Hiddo J L AU - Heerspink HJL AD - University of Groningen, Groningen, the Netherlands. FAU - Manley, Tom AU - Manley T AD - National Kidney Foundation, New York, NY. FAU - McGuire, Darren K AU - McGuire DK AD - University of Texas Southwestern Medical Center, Dallas, TX. FAU - Molitch, Mark E AU - Molitch ME AD - Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern, University Feinberg School of Medicine, Chicago, IL. FAU - Mottl, Amy K AU - Mottl AK AD - University of North Carolina School of Medicine, Chapel Hill, NC. FAU - Perreault, Leigh AU - Perreault L AD - University of Colorado Anschutz Medical Campus, Aurora, CO. FAU - Rosas, Sylvia E AU - Rosas SE AD - Joslin Diabetes Center and Harvard Medical School, Boston, MA. FAU - Rossing, Peter AU - Rossing P AD - Steno Diabetes Center Copenhagen, Gentofte; University of Copenhagen, Copenhagen, Denmark. FAU - Sola, Laura AU - Sola L AD - University of the Republic, Montevideo, Uruguay. FAU - Vallon, Volker AU - Vallon V AD - University of California-San Diego, La Jolla, CA. FAU - Wanner, Christoph AU - Wanner C AD - Division of Nephrology, University Hospital Wurzburg, Wurzburg, Germany. FAU - Perkovic, Vlado AU - Perkovic V AD - George Institute for Global Health, UNSW Sydney, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20201026 PL - United States TA - Am J Kidney Dis JT - American journal of kidney diseases : the official journal of the National Kidney Foundation JID - 8110075 RN - 0 (Protective Agents) RN - 0 (Sodium-Glucose Transporter 2 Inhibitors) SB - IM MH - Cardiovascular Diseases/epidemiology/prevention & control MH - *Diabetes Mellitus, Type 2/drug therapy/metabolism MH - *Diabetic Nephropathies/metabolism/physiopathology/prevention & control MH - Humans MH - Protective Agents/pharmacology MH - Research MH - Risk Adjustment/*methods MH - Sodium-Glucose Transporter 2 Inhibitors/*pharmacology OTO - NOTNLM OT - Hyperglycemia OT - SGLT2 inhibitor OT - atherosclerotic cardiovascular disease (ASCVD) OT - diabetic kidney disease (DKD) OT - heart failure (HF) OT - kidney protection OT - major adverse cardiovascular events (MACE) OT - renal function preservation OT - research priorities OT - review OT - sodium/glucose cotransporter 2 (SGLT2) EDAT- 2020/10/31 06:00 MHDA- 2021/02/05 06:00 CRDT- 2020/10/30 05:35 PHST- 2020/04/28 00:00 [received] PHST- 2020/08/04 00:00 [accepted] PHST- 2020/10/31 06:00 [pubmed] PHST- 2021/02/05 06:00 [medline] PHST- 2020/10/30 05:35 [entrez] AID - S0272-6386(20)30934-3 [pii] AID - 10.1053/j.ajkd.2020.08.003 [doi] PST - ppublish SO - Am J Kidney Dis. 2021 Jan;77(1):94-109. doi: 10.1053/j.ajkd.2020.08.003. Epub 2020 Oct 26.