Special Sections

Special Sections

The adult gut harbors 100 trillion bacteria. This is tenfold greater than the number of cells in the human body. The abundance and diversity of bacteria increase from the stomach (10^2 to 10^4 cells/mL) to the colon (>1012 cells/mL) as oxygen tension decreases. Given the vast number of microorganisms concentrated in the intestinal tract, it is not surprising that the products of bacterial metabolism modulate the health of the host.

The increasing prevalence of type 2 diabetes in recent decades is the primary factor accounting for the substantial global increase in kidney failure. Currently, more than 3 million people worldwide are estimated to be receiving treatment for kidney failure, with predictions that the number will increase to more than 5 million by 2035 (1). Sodium-glucose cotransporter 2 (SGLT2) inhibitors were developed to lower blood glucose levels in patients with type 2 diabetes.

The rising prevalence of diabetes, hypertension, and obesity is largely responsible for a global pandemic of chronic kidney disease (CKD), which is associated with adverse health outcomes, including kidney failure, cardiovascular disease, and death. The public health and societal burdens associated with this pandemic are considerable because of the high cost of treating these patients and the loss of productivity from disability. These problems are greatly amplified among those in low-income and middle-income countries, where 78% of the nearly 700 million persons with CKD reside.

Results from 2 large clinical trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors presented at the European Society of Cardiology (ESC) Congress 2020 show that the drugs may offer substantial kidney-protecting benefits.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic medications that have been demonstrated to improve cardiovascular outcomes in patients with diabetes. SGLT2 inhibitors regulate serum glucose levels by selectively blocking type 2 glucose transporters in the proximal convoluted tubules, thereby reducing the amount of glucose and sodium reabsorbed.

Issues related to vascular access—the timing of creation, type, site, access care, maintenance, surveillance, early identification of problems, and appropriate resolution—are important determinants of the short-term and long-term outcomes and cost of care of patients receiving maintenance hemodialysis (HD). Calling vascular access the lifeline of these individuals is not an exaggeration.