慢性腎臟病照護的新里程碑－SGLT2抑制劑

Chronic kidney disease is a high prevalence disease worldwide but the improvement on all caused mortality in recent decades was unsatisfactory. The evidence-based renal protective agents for chronic kidney disease patients were also relatively scarce, especially for those with non-diabetic kidney disease patients. In recent large randomized controlled trials, Sodium-glucose cotransporters 2 (SGLT2) inhibitors are shown to ameliorate the decline of glomerular filtration rate, reduce proteinuria, death from renal or cardiovascular causes and even improve allcause mortality rate. In addition, results from the DAPA-CKD study also revealed similar protective effect on renal outcomes. The possible mechanism of renoprotective effects includes: (1) reducing glomerular capillary pressure through restoring tubuloglomerular feedback; (2) ameliorating renal tubules injury by decreasing proximal tubules oxidative stress; (3) reducing renal interstitial edema; (4) diminish inflammatory response and tissue fibrosis. Furthermore, despite emerging evidence of cardiorenal protective effects, SGLT2 inhibitors is associated with several adverse events including hypoglycemia (especially when combined use of insulin or insulin secretagogues), genitourinary tract infection and diabetic ketoacidosis. Among patients with critical illness, poor intake, or prolong fasting, the temporary discontinued use of SGLT2 inhibitors is suggested to avoid the risk of ketoacidosis.