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Type 2 diabetes and the kidney: Insights from cardiovascular outcome trials
Author(s) -
Giugliano Dario,
De Nicola Luca,
Maiorino Maria Ida,
Bellastella Giuseppe,
Esposito Katherine
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13743
Subject(s) - saxagliptin , medicine , lixisenatide , semaglutide , empagliflozin , sitagliptin , type 2 diabetes , linagliptin , exenatide , alogliptin , renal function , liraglutide , cardiorenal syndrome , albuminuria , diabetes mellitus , intensive care medicine , endocrinology
Diabetic kidney disease (DKD) still remains a progressive condition that is associated with higher risk of end‐stage kidney disease and significant cardiovascular morbidity and mortality. Twelve cardiovascular outcome trials in type 2 diabetes (T2D) have been published to date. Most trials with dipeptidyl‐peptidase inhibitors (SAVOR‐TIMI 53 with saxagliptin, EXAMINE with alogliptin, TECOS with sitagliptin, and CARMELINA with linagliptin) and with glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) (ELIXA with lixisenatide, LEADER with liraglutide, SUSTAIN‐6 with semaglutide, EXCSEL with exenatide once‐weekly, and HARMONY with albiglutide) pointed towards reduced albuminuria, which is a surrogate endpoint possibly heralding renal function preservation. The three trials with sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) (empagliflozin, canagliflozin and dapagliflozin) also showed a salutary effect on long‐term estimated glomerular filtration rate, suggesting that SGLT‐2is are more effective at mitigating loss of kidney function than incretin‐based therapies; moreover, SGLT‐2is also have the advantage of plausible haemodynamic mechanisms for improved renal outcomes. Despite some residual limitations linked to differences in study populations and patient characteristics, the cardiorenal protective actions of SGLT‐2is, and to a lesser extent some GLP‐1RAs, make them favourable medications for patients with T2D at increased cardiorenal risk. There is room for optimism that their use may change the paradigm of the ineluctable progression of DKD.