Kidney Week Educational Symposia-What's New with SGLT2 Inhibitors in 2023

Video Transcription

Video Summary

The session highlights how SGLT2 inhibitors have transformed nephrology after years of failed CKD trials, yet remain markedly underused (often ~10–20% in indicated patients). Speakers emphasize that the evidence base is exceptionally strong, with 13 major placebo-controlled outcome trials showing consistent reductions in CKD progression (~30–36%), heart-failure hospitalization, and cardiovascular events across diverse populations, including many without diabetes. Current and draft KDIGO guidance strongly recommends SGLT2 inhibitors for CKD patients with type 2 diabetes (eGFR ≥20), heart failure, or significant albuminuria (≥200 mg/g), while benefits in non-diabetic CKD with low albuminuria remain less certain.<br /><br />Implementation barriers include cost, unfamiliarity, diffusion of responsibility across specialties, and a “risk-treatment paradox” where higher-risk CKD patients are less likely to receive therapy. Safety discussions note genital mycotic infections as the most common adverse effect; DKA is rare outside diabetes but a major concern in type 1 diabetes. Meta-analyses suggest AKI risk is lower on SGLT2 inhibitors, and the early eGFR “dip” is common but usually modest and not associated with loss of long-term benefit.<br /><br />A major theme is “layering” therapy: combining SGLT2 inhibitors with RAS blockade, GLP-1 receptor agonists, finerenone, and possibly endothelin receptor antagonists to address residual risk, with subgroup data suggesting additive benefit and acceptable safety. Q&A focuses on whether to stop SGLT2 inhibitors during AKI (individualize; don’t reflexively stop), managing volume/diuretics, special populations (transplant, very low eGFR, dialysis, catheters/UTIs, cancer), and ongoing trials aimed at filling evidence gaps.

Asset Subtitle

Moderator(s): Steven Coca

Presentation(s):

Introduction - Steven Coca
Moving Toward Goal-Directed Medical Therapy in CKD: Updates in SGLT2 Inhibitors and Use with Other Novel Therapies - Ian de Boer
Pearls and Pitfalls of Implementing SGLT2 Inhibitors to the Bedside - Aisha Shaikh

Support is provided by an educational grant from AstraZeneca.

Meta Tag

Date 11/2/2023

Pathway 1 CKD Non-Dialysis

Pathway 2 Diabetic Kidney Disease

Session ID 470168

Session Type ES - Educational Symposium

Keywords

SGLT2 inhibitors

chronic kidney disease (CKD)

KDIGO guidelines

eGFR threshold ≥20

albuminuria ≥200 mg/g

CKD progression reduction

heart failure hospitalization

cardiovascular outcomes

implementation barriers and underuse

safety (genital mycotic infections, DKA, eGFR dip, AKI)

combination therapy layering (RAS blockade, GLP-1 RA, finerenone)