Novou možnosťou prevencie diabetickej obličkovej choroby (nefropatie) u pacientov s ochorením diabetes mellitus 2. typu sú inhibítory sodíkovo-glukózového kotransportéra 2 (SGLT2), resp. gliflozíny, ktoré okrem dobrej glykemickej kontroly a nízkeho rizika hypoglykémie vykazujú signifikantný kardiovaskulárny a nefroprotektívny benefit. Klinické štúdie zamerané na kardiovaskulárnu bezpečnosť potvrdili redukciu aj sekundárneho renálneho kompozitu o 44 % pri liečbe empagliflozínom (štúdia EMPA-REG OUTCOME), o 40 % pri liečbe kanagliflozínom (štúdia CANVAS) a o 24 % v prípade dapagliflozínu (štúdia DECLARE TIMI-58). Nová štúdia CREDENCE u diabetikov s chronickou chorobou obličiek v štádiu 2–3b potvrdila nefroprotektivitu kanagliflozínu v zmysle redukcie primárneho renálneho kompozitu o 30 %. U pacientov s diabetickou obličkovou chorobou liečba kanagliflozínom má aj kardiovaskulárny benefit s redukciou kardiovaskulárneho kompozitu o 20 % a hospitalizácii pre srdcové zlyhávanie o 39 %.V novom rozšírenom SPC je kanagliflozín indikovaný aj ako doplnok štandardnej liečby pacientov s diabetickým ochorením obličiek v dávke 100 mg/d.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, gliflozins are a new possibility of prevention of diabetic kidney disease (nephropathy) in patients with type 2 diabetes mellitus. Apart from glycemic control and low risk of hypoglycemia, gliflozins have been shown to provide significant cardiovascular and nephroprotective benefit. CVOT studies also confirmed the reduction of secondary renal composite by 44 % during the treatment by empagliflozin (study EMPA-REG OUTCOME), by 40 % in canagliflozin treatment (study CANVAS) and by 24 % in the case of dapagliflozin (study DECLARE TIMI-58). New study CREDENCE in diabetic patients with stage 2–3b of chronic kidney disease confirmed nephroprotective effect of canagliflozin in terms of reduction of primary renal composite about 30 %. In patients with diabetic kidney disease treatment with canagliflozin is associated with cardiovascular benefit with reduction of cardiovascular composite about 20 % and hospitalization for heart failure about 39 %. According to new extended SPC canagliflozin is indicated also as addition to standard treatment of patients with diabetic kidney disease in dose 100 mg/day.

1 Interná klinika JLF UK a UN Martin

Gliflozins and heart: Analyses of EMPRISE study