Physicians' Academy for Cardiovascular Education

SGLT2 inhibitor reduces CV risk factors in patients with and without renal dysfunction

Differential Effects of Dapagliflozin on Cardiovascular Risk Factors at Varying Degrees of Renal Function

Petrykiv S, Sjöström DC, Greasley PJ, et al. - Clin J Am Soc Nephrol 2017; published online ahead of print

Background

Dapagliflozin, an SGLT2 inhibitor, improves glycaemic control by decreasing renal glucose re-absorption in the kidneys and increasing urinary glucose excretion. This additionally leads to decreases in body weight, blood pressure, uric acid and albuminuria [1,2]. However, in patients with a reduced estimated glomerular filtration rate (eGFR) the increase in urinary glucose excretion and the decrease of hemoglobin A1c (HbA1c) is lowered compared with patients with preserved renal function [3,4]. This has led to a recommendation not to use SGLT2 inhibitors in patients with impaired renal function, although it is not clear whether effects of SGLT2 inhibition on other renal and cardiovascular risk markers also depend on eGFR.

In this pooled analysis of 11 randomised, controlled phase 3 clinical trials of 24-week duration, the effect of dapagliflozin on multiple renal and cardiovascular risk markers as a function of eGFR was evaluated in patients with type 2 diabetes. Moreover, it was assessed whether changes in systolic blood pressure (SBP) and body weight during dapagliflozin treatment were parallel to changes in HbA1c in patients with different eGFR levels.

Main results

Conclusion

Dapagliflozin consistently reduced blood pressure, body weight and albuminuria, independently of baseline renal function. These findings suggest that further research of the long-term benefits of SGLT2 inhibitors in patients with diabetic kidney disease might be needed.

References

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Find this article online at Clin J Am Soc Nephrol