Sodium glucose cotransporter-2 (SGLT2) inhibitors currently approved by the US Food and Drug Administration include empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro). Combination formulations are also available: empagliflozin/metformin (Synjardy), canagliflozin/metformin (Invokamet), dapagliflozin/metformin (Xigduo XR), and ertugliflozin/metformin (Segluromet).
For this year’s Kidney Watch, we look once again at the diabetic kidney disease (DKD) space as these agents enter the world of nephrology (1).
On September 30, 2020, the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2) was published. There continues to be increased discussion surrounding the use of SGLT2 inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors. These novel agents are particularly notable for being strongly supported by several studies that looked at primary outcomes, e.g., major adverse cardiovascular events (MACE) or CKD progression and kidney outcomes [effects on albuminuria or albuminuria-containing composite outcomes and effects on estimated glomerular filtration rate (eGFR) loss]. Interestingly, there have been several more publications that did not make it to the KDIGO guideline document but nevertheless, are worthy of mention because they will influence how we will use these agents in our respective clinical practices.
In Dr. Lerma’s role as KDIGO Knowledge Translation Lead, he is responsible for creating implementation tools based on the KDIGO Controversies Conferences that are used to educate clinicians around the world and prepare them for the newly updated guidelines.
Neuen BL, et al.. Kidney Watch 2019: SGLT2 inhibitors and cardiorenal outcomes. ASN Kidney News 2019; 11:14–15. https://www.asn-online.org/publications/kidneynews/archives/2019/KN_2019_02_feb.pdf
Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2020; 98:S1–S115. doi: 10.1016/j.kint.2020.06.019
Packer M, et al.. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020; 383:1413–1424. doi: 10.1056/NEJMoa2022190
Cannon CP, et al.. Cardiovascular outcomes with ertugliflozin in type 2 diabetes. N Engl J Med 2020; 383:1425–1435. doi: 10.1056/NEJMoa2004967
Heerspink HJL, et al.. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383:1436–1446. doi: 10.1056/NEJMoa2024816
Bhatt DL, et al.. Sotagliflozin in patients with diabetes and chronic kidney disease [published online ahead of print November 16, 2020]. N Engl J Med doi: 10.1056/NEJMoa2030186; https://www.nejm.org/doi/full/10.1056/NEJMoa2030186
Bakris GL, et al.. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes [published online ahead of print October 23, 2020]. N Engl J Med doi: 10.1056/NEJMoa2025845; https://www.nejm.org/doi/full/10.1056/NEJMoa2025845