Soliman Amin Roshdy, Elkhatib Mohamed, El-Khashab Sahier, Darwish Rasha Ahmed, Fayed Ahmed, Abdelaziz Tarek S, Hammad Hany, Ahmed Rabab Mahmoud, Maamoun Hoda Abdelhamid
Internal Medicine and Nephrology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
Diabetol Metab Syndr. 2025 Jun 14;17(1):214. doi: 10.1186/s13098-025-01790-w.
SGLT2 inhibitors represent a revolutionary drug class that delivers benefits exceeding those of diabetes management alone. Initially approved for type 2 diabetes management, research continually demonstrates their protective effects on kidney function across several nephrological conditions, including acute kidney injury (AKI), chronic kidney disease (CKD), dialysis-dependent kidney failure, anemia, metabolic bone disease, polycystic kidney disease (PKD), glomerulonephritis, and kidney transplantation.
This study aims to identify how SGLT2 inhibitors modify nephrological care by investigating their mechanisms of action, therapeutic outcomes, and potential applications in multiple kidney diseases. It summarizes clinical trial data alongside mechanistic insights to provide a comprehensive assessment of therapeutic outcomes beyond diabetes mellitus.
Numerous clinical studies have demonstrated that SGLT2 inhibitors reduce kidney disease progression in patients with or without diabetes. These findings indicate that SGLT2 inhibitors provide kidney protection by enhancing tubuloglomerular feedback, improving renal blood flow, and reducing inflammation and ischemic tissue damage. They also provide cardiovascular benefits to dialysis patients while maintaining effective blood flow during dialysis. SGLT2 inhibitors should not be used in autosomal dominant polycystic kidney disease (ADPKD) outside clinical trials. The potential impact of SGLT2 inhibitors on bone mineral health, particularly regarding bone mineral density (BMD) reduction and fracture risk, requires careful consideration, especially in patients with pre-existing bone health concerns. Kidney transplant recipients benefit from SGLT2 inhibitors' protective effects on kidney health and assistance with diabetes management; however, further research is needed on drug compatibility with immunosuppressants and infection prevention.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是一类具有革命性的药物，其带来的益处不仅仅局限于糖尿病管理。最初被批准用于2型糖尿病管理，研究不断证明它们对多种肾脏疾病的肾功能具有保护作用，包括急性肾损伤（AKI）、慢性肾脏病（CKD）、依赖透析的肾衰竭、贫血、代谢性骨病、多囊肾病（PKD）、肾小球肾炎和肾移植。
本研究旨在通过调查SGLT2抑制剂的作用机制、治疗效果以及在多种肾脏疾病中的潜在应用，来确定其如何改变肾脏疾病的治疗。它总结了临床试验数据以及机制方面的见解，以对糖尿病以外的治疗效果进行全面评估。
大量临床研究表明，SGLT2抑制剂可减缓有或无糖尿病患者的肾脏疾病进展。这些结果表明，SGLT2抑制剂通过增强肾小管-肾小球反馈、改善肾血流量以及减轻炎症和缺血性组织损伤来提供肾脏保护。它们还为透析患者带来心血管益处，同时在透析期间维持有效的血流量。在临床试验之外，SGLT2抑制剂不应在常染色体显性多囊肾病（ADPKD）中使用。SGLT2抑制剂对骨矿物质健康的潜在影响，特别是关于骨矿物质密度（BMD）降低和骨折风险，需要仔细考虑，尤其是在已有骨骼健康问题的患者中。肾移植受者受益于SGLT2抑制剂对肾脏健康的保护作用以及对糖尿病管理的帮助；然而，关于药物与免疫抑制剂的相容性以及感染预防方面还需要进一步研究。
