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New Therapeutic Horizons in Chronic Kidney Disease: The Role of SGLT2 Inhibitors in Clinical Practice

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Abstract

Chronic kidney disease (CKD) is a serious, progressive condition associated with significant patient morbidity. Hypertension control and use of renin-angiotensin system blockers are the cornerstones of treatment for CKD. However, even with these treatment strategies, many individuals will progress towards kidney failure. Recently, sodium–glucose cotransporter 2 (SGLT2) inhibitor clinical trials with primary renal endpoints have firmly established SGLT2 inhibition, in addition to standard of care, as an effective strategy to slow down the progression of CKD and reduce some of its associated complications. The emergence of this new clinical evidence supports the use of SGLT2 inhibitors in the management of CKD in people with and without diabetes. As licensing and guidelines for SGLT2 inhibitors are updated, there is a need to adapt CKD treatment pathways and for this class of drugs to be included as part of standard care for CKD management. In this article, we have used consensus opinion alongside the available evidence to provide support for the healthcare community involved in CKD management, regarding the role of SGLT2 inhibitors in clinical practice. By highlighting appropriate prescribing and practical considerations, we aim to encourage greater and safe use of SGLT2 inhibitors for people with CKD, both with and without diabetes.

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Acknowledgements

We thank David Wheeler of the University College, London for reviewing the manuscript.

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Authors and Affiliations

  1. Diabetes Resource Centre, University Hospital Llandough, Penlan Road, Llandough Cardiff, CF64 2XX, UK

    Marc Evans

  2. Health Economics and Outcomes Research Ltd, Cardiff, UK

    Angharad R. Morgan

  3. Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

    Martin B. Whyte

  4. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Wasim Hanif

  5. Diabetes Research Unit, Swansea University Medical School, Swansea, UK

    Stephen C. Bain

  6. Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Group, Salford, UK

    Philip A. Kalra

  7. Woodlands Medical Centre, Cardiff, UK

    Sarah Davies

  8. East Sussex Healthcare NHS Trust, Seaford, UK

    Umesh Dashora

  9. Department of Cardiology, University Hospital of Wales and Cardiff University, Cardiff, UK

    Zaheer Yousef

  10. Division of Medicine, Department of Diabetes, University College London, Royal Free Campus, London, UK

    Dipesh C. Patel

  11. Diabetes and Vascular Research Centre, University of Exeter Medical School, Exeter, UK

    W. David Strain

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  1. Marc Evans
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Correspondence to Marc Evans.

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This manuscript was supported by a grant from AstraZeneca UK Ltd. in respect to medical writing and publication costs. AstraZeneca has not influenced the content of the publication, nor been involved in the design, collection, analysis, or reporting of any data presented. AstraZeneca UK Ltd. has reviewed this document for factual accuracy only.

Conflicts of interest

ME reports honoraria from AstraZeneca, Novo Nordisk, Takeda, and NAPP and research support from Novo Nordisk outside the submitted work. ARM is an employee of Health Economics and Outcomes Research Ltd., Cardiff, UK, who received fees from AstraZeneca in relation to this study. MBW reports investigator-led research grants from Sanofi, Eli Lilly, and AstraZeneca and personal fees from AstraZeneca, Boehringer Ingelheim, and MSD outside the submitted work. WH reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from NAPP, and from MSD, outside the submitted work. SCB reports personal fees and other from Abbott, personal fees and other from AstraZeneca, personal fees and other from Boehringer Ingelheim, personal fees and other from Eli Lilly, personal fees and other from Merck Sharp & Dohme, personal fees and other from Novo Nordisk, personal fees and other from Sanofi-Aventis, other from Cardiff University, other from Doctors.net, other from Elsevier, other from OnMedica, other from OmniaMed, other from Medscape, other from All-Wales Medicines Strategy Group, other from National Institute for Health and Care Excellence (NICE) UK, and other from Glycosmedia, outside the submitted work. PAK reports personal fees for lecturing from Astra Zeneca, Boehringer Ingelheim, NAPP, MundiPharma, and Novo Nordisk outside the submitted work. SD has received honorarium from AstraZeneca, Boehringer Ingelheim, Lilly, Novo Nordisk, Takeda, MSD, NAPP, Bayer, and Roche for attending and participating in educational events and advisory boards, outside the submitted work. UD reports personal fees from AstraZeneca, Napp, Sanofi, BI, Lilly, and Novo Nordisk, outside the submitted work. ZY reports personal fees from AstraZeneca, personal fees from Lilly, personal fees from Boehringer Ingelheim, and personal fees from Novartis outside the submitted work. DCP reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Eli Lilly, non-financial support from Napp, personal fees from Novo Nordisk, personal fees from MSD, and personal fees and non-financial support from Sanofi outside the submitted work. In addition, DCP is an executive committee member of the Association of British Clinical Diabetologists and member of the CaReMe UK group. WDS holds research grants from Bayer, Novo Nordisk, and Novartis and has received speaker honoraria from AstraZeneca, Bayer, Bristol-Myers Squibb, Merck, Napp, Novartis, Novo Nordisk, and Takeda. WDS is supported by the NIHR Exeter Clinical Research Facility and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula.

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All authors have been involved in the design of this review. Marc Evans and Angharad R Morgan produced the primary manuscript. All authors have contributed to the drafting and revision of the manuscript. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

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Evans, M., Morgan, A.R., Whyte, M.B. et al. New Therapeutic Horizons in Chronic Kidney Disease: The Role of SGLT2 Inhibitors in Clinical Practice. Drugs 82, 97–108 (2022). https://doi.org/10.1007/s40265-021-01655-2

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  • DOI: https://doi.org/10.1007/s40265-021-01655-2

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