Kidney Week Educational Symposia-A Practical Approach to Using SGLT2 Inhibitors for Cardiorenal Protection

Video Transcription

Video Summary

The symposium reviews evidence and practical guidance for using SGLT2 inhibitors to protect kidneys and the cardiovascular system. Prof. Remuzzi highlights real‑world CKD data showing an expected early eGFR “dip” followed by slower long‑term decline and fewer major renal events, likely related to reduced hyperfiltration. He emphasizes that improving hyperfiltration predicts better long‑term outcomes and presents experimental work suggesting SGLT2 may be expressed in podocytes; inhibition may reduce podocyte injury and proteinuria, including in nephrotic‑range proteinuria. His key message: start therapy early, before irreversible glomerular damage.<br /><br />Dr. DeBoer summarizes major trials across populations: cardiovascular outcome trials in type 2 diabetes (EMPA‑REG, CANVAS, DECLARE, VERTIS), dedicated CKD trials (CREDENCE, DAPA‑CKD, ongoing EMPA‑Kidney), and heart failure trials (DAPA‑HF, EMPEROR‑Reduced). Meta‑analyses suggest class benefits: ~10% MACE reduction, ~15% lower cardiovascular death, and ~30% fewer heart‑failure hospitalizations. Kidney outcomes improve substantially (large reductions in CKD progression/ESKD), with benefits seen even without diabetes (DAPA‑CKD; heart failure trials). Risks include genital mycotic infections, rare DKA, small volume depletion risk; UTIs are not increased and AKI risk appears reduced.<br /><br />A final talk focuses on implementation: uptake of proven therapies (ACEi/ARBs) is poor, so realizing SGLT2 benefits requires guideline alignment, education (especially primary care), practical prescribing (adjust hypoglycemics/diuretics, accept up to ~30% eGFR dip, “sick day” holds), and improved access/coverage.

Asset Subtitle

Giuseppe Remuzzi, Ian de Boer, Amy Mottl
Support is provided by an educational grant from AstraZeneca Pharmaceuticals.

Keywords

SGLT2 inhibitors

chronic kidney disease (CKD)

eGFR dip and hyperfiltration

renal protection and ESKD prevention

cardiovascular outcomes (MACE reduction)

heart failure hospitalization reduction

type 2 diabetes trials (EMPA-REG, CANVAS, DECLARE, VERTIS)

CKD trials (CREDENCE, DAPA-CKD, EMPA-Kidney)

implementation and prescribing guidance (sick day rules, diuretics adjustment)