Based on the results of several clinical trials, SGLT2 inhibitors "clearly merit" a key role in the management of patients with chronic kidney disease and heart failure, according to a translational perspective published Jan. 25 in JACC: Basic to Translational Science.

David Z.I. Cherney, MD, PhD, and Subodh Verma, MD, PhD, discuss the results of the DAPA-CKD trial and how it showed the kidney benefits of SGLT2 inhibitors are independent of glucose-lowering, and emphasize the urgency to adopt these therapies in patients with appropriate indications.

The authors also discuss what is known about the mechanisms responsible for SGLT2 inhibitors and kidney protection beyond the glucose independence. They further describe patient profiles where these therapies should either be avoided or used with caution.

They explain that for patients with lower estimates of glomerular filtration rate (eGFR) and normo- or microalbuminuria, the upcoming EMPA-KIDNEY trial will "fill a crucial knowledge gap around efficacy and safety in people with lower eGFR and lower urine albumin-to-creatinine ratio (UACR) who were not included in the CREDENCE, DAPA-CKD, or older renin-angiotensin system (RAS) inhibitor trials such as the IDNT and RENAAL."

"The DAPA-CKD trial ... clearly emphasizes the importance of measuring UACR as a biomarker in primary care, endocrinology, cardiology, nephrology and general medicine practices to identify individuals who are candidates for SGLT2 inhibitors, regardless of background cardiovascular disease status," write Cherney and Verma.

They conclude that moving forward, "to avoid the low rates of uptake that occurred with RAS inhibitors, obstacles such as therapeutic inertia, additional cost, and pill burden need to be overcome to appropriately translate the results of the DAPA-CKD trail into clinical practice."

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Lipid Metabolism, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Sodium-Glucose Transporter 2, Creatinine, Glomerular Filtration Rate, Cardiovascular Diseases, Renin-Angiotensin System, Nephrology, Glucose, Albuminuria, Renal Insufficiency, Chronic, Kidney, Heart Failure, Cardiology, Biomarkers, Primary Health Care, Albumins

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