SGLT-2 Inhibition: A Potential New Treatment for Diabetic Kidney Disease?

Diabetic nephropathy is the leading cause of kidney failure. Treatments with drugs that block the renin–angiotensin system have proven beneficial in slowing kidney disease progression among those with diabetes; their benefit is limited and they do not stop disease progression. Despite multiple clinical trials of various interventions including dual blockade of the renin–angiotensin system over the past 15 years, no new therapies have emerged to slow kidney disease progression in diabetes. SGLT-2 inhibitors are a new class of antiglycemic drugs that have been shown to lower blood glucose by inhibition of the sodium-glucose transporter 2 in the proximal tubule of the kidney. Several of these inhibitors have been marketed for treatment of hyperglycemia in patients with type 2 diabetes mellitus. In a recent double-blind randomized and placebo-controlled trial of cardiovascular outcomes, an SGLT-2 inhibitor-based intervention using empagliflozin was shown to be superior to placebo-based regimen for reducing the risk of major cardiovascular events among people with type 2 diabetes and established cardiovascular disease. In a pre-specified secondary analysis of renal outcomes from this trial, Wanner et al. [N Engl J Med 2016; 375: 323–334] recently reported that empagliflozin administration was also associated with significant reductions in the Received: September 9, 2016 Accepted after revision: September 14, 2016 Published online: July 26, 2017 Prof. Robert D. Toto Department of Internal Medicine University of Texas Southwestern Medical Center 5323 Harry Hines Blvd., B3.102, Dallas, TX 75390 (USA) E-Mail robert.toto @ utsouthwestern.edu © 2017 S. Karger AG, Basel