Use of sodium-glucose co-transporter-2 inhibitors in Asian patients with type 2 diabetes and kidney disease: An Asian perspective and expert recommendations

Khoo, Chin Meng and Deerochanawong, Chaicharn and Chan, Siew Pheng and Matawaran, Bien and Sheu, Wayne Huey-Herng and Chan, Juliana and Mithal, Ambrish and Luk, Andrea and Suastika, Ketut and Yoon, Kun-Ho and Ji, Linong and Man, Nguyen Huu and Pollock, Carol (2021) Use of sodium-glucose co-transporter-2 inhibitors in Asian patients with type 2 diabetes and kidney disease: An Asian perspective and expert recommendations. Diabetes Obesity & Metabolism, 23 (2). pp. 299-317. ISSN 1462-8902, DOI https://doi.org/10.1111/dom.14251.

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Abstract

Early onset of type 2 diabetes and a high prevalence of co-morbidities predispose the Asian population to a high risk for, and rapid progression of, diabetic kidney disease (DKD). Apart from renin-angiotensin system inhibitors, sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been shown to delay renal disease progression in patients with DKD. In this review article, we consolidate the existing literature on SGLT-2 inhibitor use in Asian patients with DKD to establish contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, data from studies on Asian patients with DKD, global trials (DAPA-CKD, CREDENCE and DELIGHT) and cardiovascular outcomes trials. In patients with DKD, SGLT-2 inhibitor therapy significantly reduced albuminuria and the risk of hard renal outcomes (defined as the onset of end-stage kidney disease, substantial decline in renal function from baseline and renal death), cardiovascular outcomes and hospitalization for heart failure. In all the cardiovascular and renal outcomes trials, there was an initial decline in the estimated glomerular filtration rate (eGFR), which was followed by a slowing in the decline of renal function compared with that seen with placebo. Despite an attenuation in glucose-lowering efficacy in patients with low eGFR, there were sustained reductions in body weight and blood pressure, and an increase in haematocrit. Based on the available evidence, we conclude that SGLT-2 inhibitors represent an evidence-based therapeutic option for delaying the progression of renal disease in Asian patients with DKD and preserving renal function in patients at high risk of kidney disease.

Item Type: Article
Funders: AstraZeneca
Uncontrolled Keywords: Diabetes;Diabetic kidney disease;Diabetic nephropathy; Gliflozins;Renal disease;SGLT;Type 2 diabetes
Subjects: R Medicine
R Medicine > R Medicine (General)
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 14 Sep 2022 08:21
Last Modified: 14 Sep 2022 08:21
URI: http://eprints.um.edu.my/id/eprint/34528

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