Abstract
Chronic kidney disease (CKD) is a medical condition with serious medical and social consequences. If not diagnosed and treated early, it is associated with a significant burden on health systems.
It is also an independent risk factor for cardiovascular and all-cause mortality. Diabetic kidney disease develops in 30-50% of diabetic patients and is the leading cause of end-stage renal disease in the western world.
Strict blood pressure control and renin-angiotensin system blockade are the mainstays of treatment for kidney disease, but not all patients achieve target values, and many patients progress to CKD. Over the past few years, we have evidence from robust studies suggesting that sodium-glucose cotransporter-2 (SGLT-2) inhibitors have potent nephroprotective properties.
In clinical trials in patients with type 2 diabetes mellitus, these agents have been shown to reduce albuminuria and proteinuria by 30-50% and the incidence of composite renal outcomes by 40-50%. SGLT-2 inhibitors interfere with the major mechanism of proteinuric progression in CKD, i.e., glomerular hypertension and hyperfiltration.
This review summarizes current evidence from recent studies on the nephroprotective effects of SGLT-2 inhibitors and discusses their place in everyday clinical practice. Currently is discussed issue of a new recognized entity - non-albuminuric diabetic kidney disease (NADKD).