Renal haemodynamic and protective effects of renoactive drugs in type 2 diabetes: Interaction with SGLT2 inhibitors.

Abstract

Diabetic kidney disease remains the leading cause of end-stage kidney disease and a major risk factor for cardiovascular disease. Large cardiovascular outcome trials and dedicated kidney trials have shown that sodium-glucose cotransporter (SGLT)2 inhibitors reduce cardiovascular morbidity and mortality and attenuate hard renal outcomes in patients with type 2 diabetes (T2D). Underlying mechanisms explaining these renal benefits may be mediated by decreased glomerular hypertension, possibly by vasodilation of the post-glomerular arteriole. People with T2D often receive several different drugs, some of which could also impact the renal vasculature, and could therefore modify both renal efficacy and safety of SGLT2 inhibition. The most commonly prescribed drugs that could interact with SGLT2 inhibitors on renal haemodynamic function include renin-angiotensin system inhibitors, calcium channel blockers and diuretics. Herein, we review the effects of these drugs on renal haemodynamic function in people with T2D and focus on studies that measured glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) with gold-standard techniques. In addition, we posit, based on these observations, potential interactions with SGLT2 inhibitors with an emphasis on efficacy and safety.

• Authors: Rosalie A Scholtes, Michaël J B van Baar, Megan D Kok, Petter Bjornstad, David Z I Cherney, Jaap A Joles, Daniël H van Raalte
• Journal: Nephrology (Carlton, Vic.) (Nephrology (Carlton)) Vol. 26 Issue 5 Pg. 377-390 (May 2021) ISSN: 1440-1797 [Electronic] Australia
• PMID: 33283420 (Publication Type: Journal Article, Review)
• Copyright: © 2020 The Authors. Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.

Chemical References

• Calcium Channel Blockers
• Diuretics
• Sodium-Glucose Transporter 2 Inhibitors

Topics

• Calcium Channel Blockers (pharmacology, therapeutic use)
• Diabetes Mellitus, Type 2 (drug therapy, physiopathology)
• Diabetic Nephropathies (prevention & control)
• Diuretics (pharmacology, therapeutic use)
• Drug Interactions
• Hemodynamics (drug effects)
• Humans
• Renal Circulation (drug effects)
• Renin-Angiotensin System (drug effects)
• Sodium-Glucose Transporter 2 Inhibitors (pharmacology, therapeutic use)