Top Things to Know: Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease
Published: September 28, 2020
- Chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2D) represents a major public health problem and accounts for majority of patients with end stage kidney disease (ESKD) in the U.S. and worldwide.
- This scientific statement provides a comprehensive summary of the major clinical trials of sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1 RA).
- Despite high-level evidence showing the cardiorenal protective effects of SGLT2i and GLP-1RAs, these agents are underutilized in clinical practice, particularly in high-risk patient populations.
- Data increasingly indicates that SGLT2i and GLP-1RA therapies may be used safely in patients with CKD, including those without T2D.
- SGLT2 expression increases in the setting of type 1 or type 2 DM, and SGLT2 inhibition is a novel molecular mechanism for treatment of T2D and CKD.
- SGLT2i show benefits in patients with heart failure with reduced ejection fraction (HFrEF), independent of diabetes status.
- GLP-1RAs provide cardioprotective effects by predominantly reducing the burden of atherosclerotic cardiovascular disease (ASCVD), while SGLT2i predominantly reduces the risk for heart failure (HF) and the need for HF hospitalizations.
- Since high-quality clinical trials have shown that patients with CVD and CKD benefit from the GLP-1RA and SGLT2i drug classes, there is a need to incorporate multidisciplinary care decisions to identify high-risk patients who may benefit from these agents.
- This statement suggests a practical collaborative care model among cardiologists, nephrologists, endocrinologists, primary care physicians and advanced practice healthcare professionals to facilitate prompt, appropriate integration of these therapeutic classes in the management of patients with T2D and CKD.
- With multidisciplinary efforts focused on providing targeted therapies for CVD and CKD risk reduction in patients with T2DM, there is opportunity to meaningfully reduce morbidity, mortality and healthcare expenditures for this vulnerable patient population.
Citation
Rangaswami J, Bhalla V, de Boer IH, Staruschenko A, Sharp JA, Singh RR, Lo KB, Tuttle K, Vaduganathan M, Ventura H, McCullough PA; on behalf of the American Heart Association Council on the Kidney in Cardiovascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Lifestyle and Cardiometabolic Health. Cardiorenal protection with the newer antidiabetic agents in patients with diabetes and chronic kidney disease:a scientific statement from the American Heart Association [published online ahead of print September 28, 2020]. Circulation. doi: 10.1161/CIR.0000000000000920