Uma análise dos benefícios dos Inibidores do SGLT2 na evolução da doença renal crônica além do diabetes mellitus tipo 2
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Resumo
Objetivo: Analisar o benefício e a segurança do uso dos Inibidores do SGLT2 na progressão da doença renal crônica (DRC) em pacientes diabéticos e não diabéticos. Revisão bibliográfica: A doença renal crônica aumenta os riscos de eventos cardiovasculares e renais, além de diminuir a expectativa e qualidade de vida. A maior causa de DRC no mundo é diabetes mellitus tipo 2, tratada inclusive com os inibidores do SGLT2. No entanto, há uma parcela da população que possui DRC por causas não diabéticas que também é beneficiada com o uso dessa classe de medicamentos. Os Inibidores de SGLT2 exercem mecanismo renoprotetor, mediado pelo feedback tubuloglomerular através da diminuição da reabsorção tubular proximal de sódio com vasoconstrição arteriolar aferente glomerular, revertendo a hipertensão intraglomerular. Há uma queda inicial da função renal após o uso dos Inibidores de SGLT2, que é revertida a longo prazo com continuação do uso desses medicamentos. Considerações finais: Os Inibidores da SGLT2 retardam a progressão da doença renal crônica e reduzem, com segurança, os riscos de mortalidade cardiovascular e insuficiência renal em pacientes com DRC com ou sem DM tipo 2.
##plugins.themes.bootstrap3.article.details##
Copyright © | Todos os direitos reservados.
A revista detém os direitos autorais exclusivos de publicação deste artigo nos termos da lei 9610/98.
Reprodução parcial
É livre o uso de partes do texto, figuras e questionário do artigo, sendo obrigatória a citação dos autores e revista.
Reprodução total
É expressamente proibida, devendo ser autorizada pela revista.
Referências
2. CHARYTAN DM, et al. Cardiorenal protective effects of canagliflozin in CREDENCE according to glucose lowering. BMJ Open Diabetes Research and Care, 2023; 11(3): 003270.
3. CHERTOW GM, et al. Effects of Dapagliflozin in Stage 4 Chronic Kidney Disease. Journal of the American Society Nephrology, 2021; 32(9): 2352-2361.
4. EMPA-KIDNEY COLLABORATIVE GROUP. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes and Endocrinology, 2024; 12(1): 39-50.
5. EMPA-KIDNEY COLLABORATIVE GROUP. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes and Endocrinology, 2024; 12(1): 51-60.
6. HEERSPINK HJL, et al. A pre-specified analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial on the incidence of abrupt declines in kidney function. Kidney International, 2022; 101(1): 174-184.
7. HEERSPINK HJL, et al. Effects of dapagliflozin on mortality in patients with chronic kidney disease: a pre-specified analysis from the DAPA-CKD randomized controlled trial. European Heart Journal, 2021; 42(13): 1216-1227.
8. HEERSPINK HJL, et al. Dapagliflozin in Patients with Chronic Kidney Disease. The NEW ENGLAND JOURNAL of MEDICINE, 2020; 383(15): 1436-1446.
9. HERRINGTON WG, et al. Cardiac, renal, and metabolic effects of sodium–glucose co-transporter 2 inhibitors: a position paper from the European Society of Cardiology ad-hoc task force on sodium–glucose co-transporter 2 inhibitors. European Journal of Heart Failure, 2021; 23(8): 1260-1275.
10. JARDINE MJ, et al. Renal, Cardiovascular, and Safety Outcomes of Canagliflozin by Baseline Kidney Function: A Secondary Analysis of the CREDENCE Randomized Trial. Journal of the American Society Nephrology, 2020; 31(5): 1128-1139.
11. JARDINE MJ, et al. Kidney, Cardiovascular, and Safety Outcomes of Canagliflozin according to Baseline Albuminuria: A CREDENCE Secondary Analysis. Clinical journal of the American Society Nephrology, 2021; 16(3): 384-395.
12. JONGS N, et al. Correlates and Consequences of an Acute Change in eGFR in Response to the SGLT2 Inhibitor Dapagliflozin in Patients with CKD. Journal of the American Society Nephrology, 2022; 33(11): 2094-2107.
13. MCMURRAY JJV, et al. Effects of Dapagliflozin in Patients with Kidney Disease, With and Without Heart Failure. JACC Heart Failure, 2021; 9(11): 807-820.
14. MOSENZON O, et al. Dapagliflozin and Prevention of Kidney Disease Among Patients with Type 2 Diabetes: Post Hoc Analyses from the DECLARE-TIMI 58 Trial. Diabetes Care, 2022; 45(10): 2350–2359.
15. OSHIMA M, et al. Insights from CREDENCE trial indicate an acute drop in estimated glomerular filtration rate during treatment with canagliflozin with implications for clinical practice. Kidney International, 2020; 99(4): 999-1009.
16. PERKOVIC V. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. The new england journal of medicine, 2019; 380(24): 2295-2306.
17. SHIBATA R, et al. Effect of dapagliflozin on the initial estimated glomerular filtration rate dip in chronic kidney disease patients without diabetes mellitus. Clinical and Experimental Nephrology, 2022; 27(1): 44-53.
18. THE EMPA-KIDNEY COLLABORATIVE GROUP. Empagliflozin in Patients with Chronic Kidney Disease. The new england journal of medicine, 2023; 388(2): 117-127.
19. VART P, et al. Efficacy and Safety of Dapagliflozin in Patients with Chronic Kidney Disease Across the Spectrum of Frailty. The Journals of Gerontology: Series A, 2023; 79(2): 181.
20. WAIJER SW, et al. Effect of dapagliflozin on kidney and cardiovascular outcomes by baseline KDIGO risk categories: a post hoc analysis of the DAPA-CKD trial. Diabetologia, 2022; 65(7): 1085-1097.
21. WHEELER DC, et al. The dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial: baseline characteristics. Nephrology Dialysis Transplantation, 2020; 35(10): 1700-1711.