Data Make It Clear: SGLT2 Inhibitors Can Be Used in Most Common Kidney Diagnoses, Says Dr William G. Herrington

While sodium-glucose cotransporter-2 (SGLT2) inhibitors are regularly used in diabetes, new indications are moving them into treatment of chronic kidney disease irrespective of diabetes status.

The data shows that dapagliflozin and empagliflozin are efficacious and can be used in all common kidney diagnoses with few exceptions, said William G. Herrington, MD, MBBS, MA, clinician scientist, Nuffield Department of Population Health, University of Oxford, and practicing honorary consultant nephrologist at Oxford Kidney Unit.

He is also the chief investigator of the EMPA-KIDNEY trial. Results of EMPA-KIDNEY were released at the Kidney Week 2022 after the study was stopped early in March 2022 based on positive efficacy.

Transcript

SGLT2 inhibitors are a foundation of diabetes treatment at this point. Now empagliflozin and dapagliflozin are both approved to treat CKD in patients without diabetes. How does this change disease management and advance treatment of CKD?

There have been indications awarded to both dapagliflozin and empagliflozin, for treating adults with chronic kidney disease, irrespective of their diabetes status—so, people with or without diabetes. These are the first drugs ever to be granted such indications. It's really remarkable how beneficial they are in people with nondiabetic causes of kidney disease.

Now, some people with diabetes will have kidney disease, and in many cases, it won't be the diabetes that has caused their kidney disease. So, what's wonderful about the data we have from these trials, which show that these drugs are broadly, similarly efficacious across a range of different types of kidney diseases, is it makes writing clinical practice guidelines, and hence clinical practice really simple.

There isn't really a kidney diagnosis, a common kidney diagnosis, where we don't use these drugs. The exceptions are 2 groups of patients that haven't been as well tested…. [In] people with type 1 diabetes, [there is an] uncertainty about the absolute benefits and risk balance in people with type 1 diabetes, because of the risk of ketoacidosis. And none of the drugs at the moment have got an indication for use in type 1 diabetes.

The second group of patients is those with polycystic kidney disease, which were excluded from all of the definitive trials for various different reasons. And that group of patients have effectively been neglected from the studies. and they need more careful decision making and that I think, should be done with the patient’s nephrologist. A decision to start an SGLT2 inhibitor in such a patient should be in the knowledge that we haven't studied in large scale trials.