Renal haemodynamic and protective effects of renoactive drugs in type 2 diabetes: Interaction with SGLT2 inhibitors

• Published in: Nephrology (Carlton, Vic.) Vol. 26; no. 5; pp. 377 - 390
• Main Authors: Scholtes, Rosalie A., Baar, Michaël J. B., Kok, Megan D., Bjornstad, Petter, Cherney, David Z. I., Joles, Jaap A., Raalte, Daniël H.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2021; Wiley Subscription Services, Inc
• Subjects: Angiotensin; Calcium; calcium channel blockers; Calcium Channel Blockers - pharmacology; Calcium Channel Blockers - therapeutic use; Cardiovascular diseases; Clinical trials; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; diabetic kidney disease; Diabetic Nephropathies - prevention & control; Diuretics; Diuretics - pharmacology; Diuretics - therapeutic use; Drug Interactions; Drugs; Glomerular filtration rate; Hemodynamics - drug effects; Humans; Kidney diseases; Morbidity; RAS inhibitors; Renal Circulation - drug effects; Renal function; renal haemodynamic function; Renin; Renin-Angiotensin System - drug effects; Review; Reviews; Risk factors; SGLT2 inhibition; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - pharmacology; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; type 2 diabetes humans; Vasodilation; diabetic kidney disease; renal haemodynamic function; RAS inhibitors; calcium channel blockers; diuretics; SGLT2 inhibition; type 2 diabetes humans
• ISSN: 1320-5358; 1440-1797; 1440-1797
• DOI: 10.1111/nep.13839

Diabetic kidney disease remains the leading cause of end‐stage kidney disease and a major risk factor for cardiovascular disease. Large cardiovascular outcome trials and dedicated kidney trials have shown that sodium‐glucose cotransporter (SGLT)2 inhibitors reduce cardiovascular morbidity and mortality and attenuate hard renal outcomes in patients with type 2 diabetes (T2D). Underlying mechanisms explaining these renal benefits may be mediated by decreased glomerular hypertension, possibly by vasodilation of the post‐glomerular arteriole. People with T2D often receive several different drugs, some of which could also impact the renal vasculature, and could therefore modify both renal efficacy and safety of SGLT2 inhibition. The most commonly prescribed drugs that could interact with SGLT2 inhibitors on renal haemodynamic function include renin‐angiotensin system inhibitors, calcium channel blockers and diuretics. Herein, we review the effects of these drugs on renal haemodynamic function in people with T2D and focus on studies that measured glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) with gold‐standard techniques. In addition, we posit, based on these observations, potential interactions with SGLT2 inhibitors with an emphasis on efficacy and safety. SUMMARY AT A GLANCE This invited review describes the renal haemodynamic and protective effects of commonly prescribed drugs in people with type 2 diabetes and their interaction with SGLT2 inhibitors.