SGLT-2 inhibitors in patients with diabetic kidney disease

Dr Jürgen Floege is a professor of medicine and director of the Division of Nephrology and Clinical Immunology at the University Hospital RWTH Aachen (Germany), Distinguished Fellow of the European Renal Association (ERA-EDTA), and member of the International Society of Nephrology.

Do you think that inhibitors of renal sodium-glucose cotransporter-2 (SGLT-2) will become, or already are, the key drugs for patients with diabetes and chronic kidney disease?

Jürgen Floege, MD, PhD: SGLT-2 inhibitors, like empagliflozin or dapagliflozin, have certainly revolutionized the approach to diabetic kidney disease. They are the only drugs which have proven efficacy in lowering mortality [and] in retarding kidney failure. And funny enough, for example, insulin does not do that. We have been treating patients with insulin for ages yet it does not change your mortality. SGLT-2 inhibitors do. So, they will certainly become the drugs of choice in this situation.

For nephrologists currently the most interesting question is whether they also work in nondiabetic kidney disease. There are several large trials ongoing testing that. There is a good rationale behind it but we need to test it.

And of course, as a nephrologist I am always interested in cardiology as well. SGLT-2 inhibitors in heart failure is another very hot topic. It is conceivable that in the future these antidiabetic drugs will be used for diabetes and for many other things as well.