Rewriting Medical Textbooks: The Kidney as a Window to the Heart – The Role of Sodium–Glucose Transport Protein 2 Inhibitors in Cardiovascular and Renal Disease in Type 2 Diabetes Mellitus

Abstract

This symposium took place during the 2019 meeting of the European Association for the Study of Diabetes (EASD). Focussing on the kidney as a window to the heart, the speakers discussed connections between the kidney and the heart, potential mechanisms, and the role of sodium–glucose co-transporter 2 (SGLT2) inhibitors in patient management. Prof De Nicola set the scene with projected numbers of patients with diabetes and diabetic nephropathy. Prof DeFronzo gave a description of the natural history of diabetic nephropathy, microalbuminuria as a predictor of chronic kidney disease (CKD), and the Steno hypothesis linking impaired vascular endothelial dysfunction with vascular leakage of albumin. He concluded his talk by describing why patients with CKD are predisposed to cardiovascular disease (CVD). Prof Groop provided insights into the mechanisms of renal protection by SLGT2 inhibitors. He explained the ‘tubular hypothesis’, whereby SLGT2 inhibitors correct glomerular hypertension by inhibiting tubuloglomerular feedback (TGF). Prof Perkovic highlighted data from randomised controlled trials which enhanced understanding of the potential effects that might be achieved with SLGT2 inhibitors. The meeting concluded with a lively discussion between panel members and the audience.