title: The kidney and type 2 diabetes mellitus: therapeutic implications of SGLT2 inhibitors.
abstract: Understanding the role of the kidneys in type 2 diabetes mellitus (T2DM) has taken on an increased importance in recent years with the arrival of sodium-glucose co-transporter 2 (SGLT2) inhibitors - antihyperglycemic agents (AHAs) that specifically target the kidneys. This review includes an update on the physiology of the kidneys, their role in the pathophysiology of T2DM, and the mechanisms implicated in the development and progression of diabetic kidney disease, such as glomerular hyperfiltration and inflammation. It also discusses renal issues that could influence the choice of AHA for patients with T2DM, including special populations such as patients with concomitant chronic kidney disease. The most recent data published on the clinical efficacy and safety of the SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin and their effects on renal function are presented, showing how the renally mediated mechanisms of action of these agents translate into clinical benefits, including the potential for renoprotection. The observed positive effects of these agents on measures such as glucose control, estimated glomerular filtration rate, albumin-to-creatinine ratio, blood pressure, and body weight in patients both with and without impaired renal function suggest that SGLT2 inhibitors represent an important extension to the diabetes treatment armamentarium.
authors.affiliation: a Division of Nephrology, Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D000419:Albuminuria; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D000068896:Canagliflozin / Q000627:therapeutic use*; D003404:Creatinine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000209:etiology / Q000378:metabolism; D005919:Glomerular Filtration Rate; D005960:Glucosides / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007668:Kidney / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000378:metabolism; D000077203:Sodium-Glucose Transporter 2 Inhibitors
chemical_list: D001559:Benzhydryl Compounds; D005960:Glucosides; D007004:Hypoglycemic Agents; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D000068896:Canagliflozin; C529054:dapagliflozin; D003404:Creatinine; C570240:empagliflozin
keywords: Kidney; Nephropathy; Pathophysiology; SGLT2; Sodium–glucose co-transporter 2; T2DM; Type 2 diabetes mellitus