SGLT2 inhibitors - A novel treatment for congestive heart failure and chronic kidney disease

Abstract

SGLT2 inhibitors increase renal excretion of sodium and glucose by blocking the SGLT2 transporters in the proximal tubule. Not only do they lower blood sugars levels but also have positive effects on blood pressure and weight. They lead to more efficient energy metabolism in the heart and kidneys, increase the production of red blood cells and decrease fibrosis and inflammation in the heart and the kidneys. Large double blind randomized trials have shown both cardiac and renal protective effects. Patient with heart failure, both with reduced and preserved ejection fraction have shown to benefit from treatment with SGLT2 inhibitors. They have lower risk of death due to cardiovascular causes and decreased risk of hospitalization because of heart failure compared to patient treated with placebo both with and without diabetes type 2. SGLT2 inhibitors are shown to decrease risk of chronic kidney disease stage 5 and dialysis, death due of cardiovascular events and doubling of serum creatinine in patients with chronic kidney disease both with and without diabetes type 2. They are now recommended for treatment of heart failure and chronic kidney disease with the highest evidence grade. SGLT2 inhibitors do not increase risk of hypoglycemia or acute kidney injury but do have a serious uncommon adverse effect that are normoglycemic ketoacidosis and Fournier's gangrene that physicians need to be alert to.