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钠-葡萄糖协同转运蛋白 2 抑制剂在糖尿病肾病治疗中的作用及机制。

Role and mechanisms of SGLT-2 inhibitors in the treatment of diabetic kidney disease.

机构信息

Guangdong Provincial Key Laboratory of Autophagy and Major Chronic Non-communicable Diseases, Key Laboratory of Prevention and Management of Chronic Kidney Diseases of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.

出版信息

Front Immunol. 2023 Sep 21;14:1213473. doi: 10.3389/fimmu.2023.1213473. eCollection 2023.


DOI:10.3389/fimmu.2023.1213473
PMID:37809091
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10552262/
Abstract

Diabetic kidney disease (DKD) is a chronic inflammatory condition that affects approximately 20-40% of individuals with diabetes. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors, emerging as novel hypoglycemic agents, have demonstrated significant cardiorenal protective effects in patients with DKD. Initially, it was believed that the efficacy of SGLT-2 inhibitors declined as the estimated glomerular filtration rate (eGFR) decreased, which led to their preferential use in DKD patients at G1-G3 stages. However, recent findings from the DAPA-CKD and EMPA-KIDNEY studies have revealed equally beneficial cardiorenal effects of SGLT-2 inhibitors in individuals at stage G4 DKD, although the underlying mechanism behind this phenomenon remains unclear. In this comprehensive analysis, we provide a systematic review of the mechanisms and functioning of SGLT-2 inhibitors, potential renal protection mechanisms, and the therapeutic efficacy and safety of SGLT-2 inhibitors in kidney diseases, with a particular focus on stage G4 DKD. Gaining a deeper understanding of the renal protective effect of SGLT-2 inhibitors and their underlying mechanisms is highly significance for the successful utilization of these inhibitors in the treatment of diverse kidney disorders.

摘要

糖尿病肾病(DKD)是一种慢性炎症性疾病,影响大约 20-40%的糖尿病患者。钠-葡萄糖共转运蛋白 2(SGLT-2)抑制剂作为新型降糖药物,已在 DKD 患者中显示出显著的心肾保护作用。最初,人们认为 SGLT-2 抑制剂的疗效随着估算肾小球滤过率(eGFR)的降低而下降,这导致它们在 G1-G3 期的 DKD 患者中优先使用。然而,DAPA-CKD 和 EMPA-KIDNEY 研究的最新发现表明,SGLT-2 抑制剂在 G4 期 DKD 患者中也具有同样有益的心肾作用,尽管其背后的机制尚不清楚。在这项全面分析中,我们系统地综述了 SGLT-2 抑制剂的作用机制、潜在的肾脏保护机制以及 SGLT-2 抑制剂在肾脏疾病中的治疗效果和安全性,特别关注 G4 期 DKD。深入了解 SGLT-2 抑制剂的肾脏保护作用及其潜在机制,对于成功利用这些抑制剂治疗各种肾脏疾病具有重要意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b272/10552262/22c97a114372/fimmu-14-1213473-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b272/10552262/150a75b1ab00/fimmu-14-1213473-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b272/10552262/22c97a114372/fimmu-14-1213473-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b272/10552262/150a75b1ab00/fimmu-14-1213473-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b272/10552262/22c97a114372/fimmu-14-1213473-g002.jpg

相似文献

[1]
Role and mechanisms of SGLT-2 inhibitors in the treatment of diabetic kidney disease.

Front Immunol. 2023

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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引用本文的文献

[1]
Comparison of SGLT-2i and GLP-1RA on cardiovascular and renal outcomes in elderly patients with T2DM: a single-center retrospective cohort study.

Int Urol Nephrol. 2025-9-5

[2]
Repurposing Diabetes Therapies in CKD: Mechanistic Insights, Clinical Outcomes and Safety of SGLT2i and GLP-1 RAs.

Pharmaceuticals (Basel). 2025-7-28

[3]
Diabetic kidney disease: exploring mechanistic depths and the future of pharmacological intervention.

Naunyn Schmiedebergs Arch Pharmacol. 2025-8-19

[4]
What a Modern Physician Should Know About microRNAs in the Diagnosis and Treatment of Diabetic Kidney Disease.

Int J Mol Sci. 2025-7-11

[5]
Probiotics as Antioxidant Strategy for Managing Diabetes Mellitus and Its Complications.

Antioxidants (Basel). 2025-6-22

[6]
Application of SGLT-2 inhibitors in non-diabetic CKD: mechanisms, efficacy, and safety.

Front Med (Lausanne). 2025-7-1

[7]
Targeting ion channel networks in diabetic kidney disease: from molecular crosstalk to precision therapeutics and clinical innovation.

Front Med (Lausanne). 2025-6-26

[8]
Effectiveness and safety of finerenone in the treatment of IgA Nephrology patients: a retrospective, real-world study.

Int Urol Nephrol. 2025-4-21

[9]
New Markers for the Assessment of Microvascular Complications in Patients with Metabolic Syndrome.

Metabolites. 2025-3-10

[10]
Short-term effects of empagliflozin on preventing contrast induced acute kidney injury in patients undergoing percutaneous coronary intervention, a randomised trial.

Sci Rep. 2025-1-31

本文引用的文献

[1]
Renal and Cardiovascular Metabolic Impact Caused by Ketogenesis of the SGLT2 Inhibitors.

Int J Mol Sci. 2023-2-18

[2]
Use of Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitor Remogliflozin and Possibility of Acute Kidney Injury in Type-2 Diabetes.

Cureus. 2022-12-15

[3]
Empagliflozin in Patients with Chronic Kidney Disease.

N Engl J Med. 2023-1-12

[4]
KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease.

Kidney Int. 2022-11

[5]
Renoprotective mechanisms of sodium-glucose co-transporter 2 (SGLT2) inhibitors against the progression of diabetic kidney disease.

J Cell Physiol. 2022-2

[6]
Risk of lower extremity amputations in patients with type 2 diabetes using sodium-glucose co-transporter 2 inhibitors.

Acta Diabetol. 2022-2

[7]
Efficacy and safety of sotagliflozin in patients with type 2 diabetes and severe renal impairment.

Diabetes Obes Metab. 2021-12

[8]
Effects of Dapagliflozin in Stage 4 Chronic Kidney Disease.

J Am Soc Nephrol. 2021-9

[9]
Sodium-Glucose Cotransporter-2 (SGLT-2) Attenuates Serum Uric Acid (SUA) Level in Patients with Type 2 Diabetes.

J Diabetes Res. 2021

[10]
Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes.

N Engl J Med. 2020-10-23

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