Amsterdam Diabetes Center, Department of Internal Medicine, Academic Medical Center, VU University Medical Center, Amsterdam, The Netherlands.
Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Nephrology (Carlton). 2021 May;26(5):377-390. doi: 10.1111/nep.13839. Epub 2021 Jan 4.
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.
糖尿病肾病仍然是终末期肾病的主要原因，也是心血管疾病的主要危险因素。大型心血管结局试验和专门的肾脏试验表明，钠-葡萄糖共转运蛋白（SGLT）2 抑制剂可降低 2 型糖尿病（T2D）患者的心血管发病率和死亡率，并减轻肾脏硬终点事件。解释这些肾脏益处的潜在机制可能是通过降低肾小球高血压介导的，可能是通过肾小球后小动脉的血管舒张。T2D 患者通常会接受多种不同的药物治疗，其中一些药物也可能影响肾脏血管系统，因此可能会改变 SGLT2 抑制剂的肾脏疗效和安全性。最常开的可能会影响 SGLT2 抑制剂对肾脏血液动力学功能的药物包括肾素-血管紧张素系统抑制剂、钙通道阻滞剂和利尿剂。在此，我们综述了这些药物对 T2D 患者肾脏血液动力学功能的影响，并重点关注了使用金标准技术测量肾小球滤过率（GFR）和有效肾血浆流量（ERPF）的研究。此外，我们基于这些观察结果，提出了与 SGLT2 抑制剂的潜在相互作用，重点关注疗效和安全性。
