Cardiorenal Syndrome in Type 2 Diabetes Mellitus - Rational Use of Sodium-glucose Cotransporter-2 Inhibitors.
Diabetes mellitus
cardiorenal protection
cardiorenal syndrome
cardiovascular outcome trials
sodium–glucose cotransporter-2 (SGLT2) inhibitors
Journal
European endocrinology
ISSN: 1758-3780
Titre abrégé: Eur Endocrinol
Pays: England
ID NLM: 101574781
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
25
02
2020
accepted:
01
07
2020
entrez:
29
10
2020
pubmed:
30
10
2020
medline:
30
10
2020
Statut:
ppublish
Résumé
Cardiorenal syndrome (CRS) in people with type 2 diabetes mellitus (T2DM) illustrates the bidirectional link between the heart and the kidneys, with acute or chronic dysfunction of one organ adversely impacting the function of the other. Of the five subtypes identified, type 1 and 2 CRS occur because of the adverse impact of cardiac conditions on the kidneys. Type 3 and 4 occur when renal conditions affect the heart, and in type 5, systemic conditions impact the heart and kidneys concurrently. The cardiovascular and renoprotective benefits evidenced with sodium-glucose cotransporter-2 (SGLT2) inhibitors make them a potential choice in the management of CRS. Cardiovascular protection is mediated by a reduction in cardiac workload, blood pressure, and body weight; with improvement in lipid profile, uric acid levels, and adaptive ketogenesis process. Renoprotection is facilitated by reduction in albuminuria and hypoxic stress, and restoration of tubuloglomerular feedback. The favourable effect on cardiovascular complications and death, as well as renal complications and progression to end-stage kidney disease, has been confirmed in clinical trials. Guidelines endorse first-line use of SGLT2 inhibitors after metformin in patients with T2DM with high cardiovascular risk, chronic kidney disease or both. Since most trials with SGLT2 inhibitors excluded subjects with acute illness, patients with CRS subtypes 1 and 3 have not been studied adequately, making SGLT2 initiation in clinical practice challenging. Ongoing trials may provide evidence for SGLT2 inhibitor use in CRS. This review aims to enhance understanding of CRS and provide guidance for judicious use of SGLT2 inhibitors in T2DM.
Identifiants
pubmed: 33117442
doi: 10.17925/EE.2020.16.2.113
pmc: PMC7572171
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
113-121Informations de copyright
© Touch Medical Media 2020.
Déclaration de conflit d'intérêts
Disclosures: Bharath Srinivasan and Amit Kumar are employees of AstraZeneca Pharma India Ltd. Sanjay Kalra, Hasan Aydin, Manisha Sahay, Sujoy Ghosh, Sundeep Ruder, Mangesh Tiwaskar, Gary Kilov, Kamal Kishor, Tiny Nair, Vikas Makkar, Ambika Gopalakrishnan Unnikrishnan, Dinesh Dhanda and Nikhil Gupta have no financial or non-financial relationships or activities to declare in relation to this article. Sanjay Kalra is a member of the journal’s Editorial Board.
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