Renal Unit, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK.
Centre for Nephrology, Urology and Transplantation, King's College London, SE5 9NU London, UK.
Rev Cardiovasc Med. 2022 Mar 3;23(3):82. doi: 10.31083/j.rcm2303082.
Sodium-glucose co-transporter (SGLT)-2 inhibitors were initially developed for management of type 2 diabetes but have been shown to offer improved outcomes in heart failure, a condition in which concomitant chronic kidney disease (CKD) is common. Randomised controlled trials initially demonstrated prognostic cardiovascular and renal benefits of SGLT2 inhibitors in high cardiovascular risk individuals with type 2 diabetes particularly in relation to heart failure. Improved outcomes have been replicated in cohorts with established heart failure and/or CKD and appear to extend in those without diabetes. Several specific agents have been considered, with evidence of a class effect, and dapagliflozin and empagliflozin are now incorporated into major international cardiovascular guidelines for management of heart failure with reduced ejection fraction. Beyond glucose lowering effects the mechanisms mediating SGLT2 inhibitors favourable actions are not fully elucidated. Haemodynamic alterations, natriuresis, osmotic diuresis, and weight loss likely contribute to improved outcomes, along with an enhanced cardiometabolic profile. The functional drop in estimated glomerular filtration rate (eGFR) which accompanies SGLT2 inhibitor initiation, before eGFR stabilisation, is likely central in the observed renal benefits. In this review we discuss in detail the evidence for SGLT2 inhibitors in heart failure, particularly with regard to kidney health.
钠-葡萄糖协同转运蛋白 (SGLT)-2 抑制剂最初是为 2 型糖尿病的治疗而开发的，但已被证明在心力衰竭中提供了更好的疗效，而心力衰竭通常伴有慢性肾脏病 (CKD)。随机对照试验最初证明了 SGLT2 抑制剂在伴有 2 型糖尿病的高心血管风险人群中的心血管和肾脏预后获益，特别是与心力衰竭有关。在已经患有心力衰竭和/或 CKD 的患者中，已经复制了这些获益，并且在没有糖尿病的患者中似乎也有所扩展。已经考虑了几种特定的药物，具有类效应的证据，达格列净和恩格列净现在已被纳入主要的国际心血管指南，用于治疗射血分数降低的心力衰竭。除了降低血糖的作用外，介导 SGLT2 抑制剂有利作用的机制尚未完全阐明。血流动力学改变、利钠作用、渗透性利尿和体重减轻可能有助于改善结局，同时改善代谢状况。在开始 SGLT2 抑制剂治疗后，肾小球滤过率估计值 (eGFR) 下降，直到 eGFR 稳定之前，这可能是观察到的肾脏获益的核心因素。在这篇综述中，我们详细讨论了 SGLT2 抑制剂在心力衰竭中的证据，特别是在肾脏健康方面。
