You'll hear buzz about using SGLT2 inhibitors (Jardiance, etc) or GLP-1 agonists (Victoza, etc) to protect the kidneys in type 2 diabetes.
We know ACE inhibitors or ARBs slow progression of nephropathy in diabetes patients with hypertension and albuminuria.
Now data suggest Jardiance (empagliflozin) or Invokana (canagliflozin) may have some kidney protective effects...probably by lowering intraglomerular pressure.
For example, using Jardiance for 3 years seems to slow progression to albuminuria for one in 20 patients with type 2 diabetes. But it only delays starting dialysis in one in 333 patients.
Victoza (liraglutide) or Ozempic (semaglutide) may also help protect the kidneys...possibly by reducing tissue inflammation.
Using Victoza for about 4 years seems to slow progression to albuminuria for one in 83 patients...but doesn't delay dialysis.
These findings seem to be independent of blood glucose lowering...and are in patients mostly on an ACEI or ARB already.
But don't jump to these diabetes meds for renal protection yet.
So far, evidence is from CV studies...mainly in patients with mild kidney disease. Plus these meds often cost at least $500/month.
Caution that flozins or GLP-1 agonists are also linked to acute kidney INJURY...especially with dehydration, vomiting, NSAIDs, etc.
Continue to focus on slowing progression of nephropathy in type 2 diabetes by controlling BP and blood glucose...and recommend adding an ACEI or ARB in patients with hypertension and albuminuria.
Consider Jardiance or Victoza if a metformin add-on is needed for patients with type 2 diabetes and CV disease or at high CV risk. These are the only two meds in these classes proven to reduce CV risk AND death.
Think of persistent albuminuria as another reason to lean toward Jardiance or Victoza in these patients...if an add-on is needed.
Listen to PL Voices to learn about renal benefits of these meds. Use our chart, Management of Albuminuria: Focus on Pharmacotherapy, for monitoring guidance and to compare treatment strategies.
- Diabetes Care 2018;41(Suppl 1):S105-S118
- N Engl J Med 2017;377(9):839-48
- N Engl J Med 2016;375(4):323-34
Medication pricing by Elsevier, accessed Aug 2018
Sharon Euers September 9, 2018
Is this statement worded correctly within the article. Caution that flozins or GLP-1 agonists are also linked to acute kidney INJURY...especially with dehydration, vomiting, NSAIDs, etc.
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