SGLT2 inhibitors in non-diabetic kidney disease

There is an accumulating evidence demonstrating renoprotective and cardioprotective role of sodium-glucose cotransporter 2 (SGLT2) inhibitors in early to advanced diabetic kidney disease. Data from recently published Dapagliflozin and Prevention of Adverse Outcomes in the Chronic Kidney Disease (DAPA-CKD) trial clearly show that dapagliflozin is similarly renoprotective in non-diabetic chronic kidney disease in a wide range of estimated glomerular filtration rate (eGFR) of 25-75 mL/min/1.73 m2 (0.42-1.25 mL/s/1.73 m2) and albumin/creatinine ratio 200-5000 mg/g (approx. 20-500 mg/mmol). Patients with type 1 diabetes, autosomal dominant polycystic kidney disease, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and lupus nephritis were excluded from the study, but, on the other hand, prespecified subanalysis demonstrated that dapagliflozin should be renoprotective also in patients with immunoglobulin A (IgA) nephropathy. The renoprotective effect of SGLT2 inhibitors is additive to the renoprotection conferred with blockers of renin-angiotensin system, including both inhibitors of angiotensin converting enzyme (ACEI), or angiotensin receptor blocker (ARB). These promising data will be hopefully confirmed by the ongoing the Study of Heart and Kidney Protection With Empagliflozin (EMPA-KIDNEY) trial, the results of which are expected later in 2022.