SGLT2 Inhibitors in Chronic Kidney Disease

This Harvard Medical School Continuing Education video examines these key questions: How do SGLT2 inhibitors provide kidney protection? What key findings in CREDENCE and DAPA-CKD, two landmark kidney outcomes trials, have led to new SGLT2i guidelines for patients with CKD? Dr. Lee-Shing Chang, MD, an endocrinologist at Brigham and Women’s Hospital in Boston, Massachusetts, describes the use of SGLT2 inhibitors—canagliflozin and dapagliflozin—for improved kidney outcomes. Key findings from two landmark kidney outcomes trials for SGLT2 inhibitors are reviewed along with the updated guidelines they led to. Finally, Dr. Chang identifies some of the proposed mechanisms by which SGLT2 inhibitors may provide kidney benefits, which is a subject of ongoing research. 00:00 | Introduction 00:39 | About SGLT2 inhibitors 01:17 | Cardiovascular and kidney outcomes trials summary 02:23 | Key findings from CREDENCE trial 03:54 | Key findings from DAPA-CKD trial 05:57 | Updates to clinical guidelines for managing T2D 07:09 | Proposed mechanisms for kidney protection with SGLT2i This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content. References: Perkovic V, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24): 2295-2306. doi:10.1056/nejmoa1811744.   Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383(1): 1436-46. doi:10.1056/NEJMoa2024816.  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(4S):S1-S115. doi:10.1016/j.kint.2020.06.019.   American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S125-S143. doi:10.2337/dc22-S009.  DeFronzo RA, Reeves WB, Awad AS. Pathophysiology of diabetic kidney disease: impact of SGLT2 inhibitors. Nat Rev Nephrol. 2021;17(5):319-334. doi:10.1038/s41581-021-00393-8.  Notice: At this time, the content in this video is not accredited