Kidney Week Educational Symposia-SGLT2 Inhibitors: Should We Put Them in the Water of Patients with CKD?

Video Transcription

Video Summary

The session features two talks on SGLT2 inhibitors for kidney and cardiovascular protection across chronic kidney disease (CKD). Dr. Meg Jardine reviews rising global CKD burden and how declining eGFR and increasing albuminuria raise risks of kidney failure, acute kidney injury (AKI), cardiovascular events, and heart failure. Earlier therapies such as ACE inhibitors/ARBs reduce progression but leave major residual risk. SGLT2 inhibitors, originally glucose-lowering drugs, showed broad organ protection in cardiovascular and renal trials. Dedicated kidney trials (CREDENCE and DAPA-CKD) demonstrated ~30–39% reductions in major renal outcomes, with benefits consistent across eGFR ranges studied (down to ~25 mL/min/1.73m²) and present with or without diabetes; absolute benefit is greatest at higher baseline risk. An initial, reversible eGFR “dip” reflects hemodynamic change, not injury. Meta-analyses show reduced AKI and strong reductions in hospitalization for heart failure, plus modest MACE and mortality benefits. Effects appear additive with RAS blockade and mineralocorticoid receptor antagonists.<br /><br />Dr. Joshua Neumiller translates evidence into practice: guidelines now recommend SGLT2 inhibitors for organ protection independent of A1c lowering, with attention to labeling by eGFR and preserved cardiorenal benefit even when glucose effects wane. He emphasizes risk mitigation: adjust insulin/sulfonylureas to prevent hypoglycemia, use sick-day and peri-procedure holds to reduce ketoacidosis risk, assess volume status/diuretics, and counsel on genital infection prevention and foot care.

Asset Subtitle

Moderators: Katie Cardone

Speakers:

Introduction - Katie Cardone
Kidney and Cardiovascular Protection with SGLT2 Inhibitors Across the Spectrum of CKD - Meg Jardine
Clinical Pearls About the Use of SGLT2 Inhibitors for Patients with CKD - Joshua Neumiller

Meta Tag

Date 11/4/2021

Pathway 1 Diabetes and Metabolism

Pathway 2 Hypertension and CVD

Session ID 406549

Session Type ES - Educational Symposium

Keywords

SGLT2 inhibitors

chronic kidney disease (CKD)

cardiorenal protection

CREDENCE trial

DAPA-CKD trial

eGFR decline and albuminuria

acute kidney injury (AKI) risk reduction

heart failure hospitalization reduction

clinical practice guidelines and risk mitigation