Dapagliflozin — a breakthrough in the treatment of chronic kidney disease from the perspective of the DAPA-CKD study

Abstract

Sodium-glucose co-transporter 2 (SGLT2) inhibitors (gliflozins) are a new group of oral antidiabetic drugs which inhibit the sodium-glucose co-transporter within the proximal tubules in the kidneys, resulting in increased excretion of glucose and sodium in the urine. This class of drugs had been initially designed to treat type 2 diabetes, but large clinical studies showed that, in addition to the antidiabetic effect, they may provide strong organ protection including potent inhibition of the progression of cardiovascular and kidney diseases. The favorable safety profile of gliflozins was also confirmed in these studies. These initial observations led to the initiation of clinical studies focused on nephroprotection as the primary endpoint. Recently, the seminal DAPA-CKD study was published which showed that dapagliflozin maintained a potent nephroprotective effect not only in patients with diabetic but also with non-diabetic kidney disease. As a result, SGLT2 inhibitors have become a new essential add-on to kidney protection therapy previously based on the inhibition of the renin-angiotensin-aldosterone system. Dapagliflozin has become the first SGLT2 inhibitor that received an extended registration indication to include not only diabetic but also non-diabetic patients with nephropathies and patients with advanced chronic renal disease. However, the awareness of the nephroprotective properties of gliflozins needs to be increased among nephrologists so that the drugs are more often recommended in patients with kidney disease regardless of the concomitance of diabetes, especially in the presence of increased albuminuria and already impaired excretory function of the kidneys.