Dapagliflozin reduces albuminuria over 2 years in patients with type 2 diabetes mellitus and renal impairment

Excerpt

To the Editor: There is a growing body of evidence that sodium-glucose co-transporter 2 (SGLT2) inhibition may confer a renoprotective effect. This beneficial renal effect is thought to be achieved by mechanisms associated with reduced glucose and sodium reabsorption in the proximal tubule leading to decreased intra-glomerular pressure through the tubuloglomerular feedback mechanism [1]. In addition, reduced glucose trafficking through the proximal tubular cells [2] may lead to decreased oxidative stress, inflammation and tubulointerstitial fibrosis. Limiting proximal tubular reabsorption and, thus, reducing hyperfiltration is an important therapeutic target, since glomerular hyperfiltration is a potential driver of renal disease progression in type 2 diabetes [1]. Furthermore, changes in albuminuria predict morbidity and mortality, as well as cardiovascular and renal outcomes in patients with type 2 diabetes [3], and a short-term beneficial effect of dapagliflozin on albumin excretion has been reported [4]. …