IMR Press / RCM / Volume 23 / Issue 3 / DOI: 10.31083/j.rcm2303082
Open Access Review
The role of sodium-glucose co-transporter (SGLT)-2 inhibitors in heart failure management and implications for the kidneys
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1 Renal Unit, King’s College Hospital NHS Foundation Trust, SE5 9RS London, UK
2 Centre for Nephrology, Urology and Transplantation, King’s College London, SE5 9NU London, UK
3 University Hospital of Heraklion, Voutes, 71300 Heraklion, Crete, Greece
4 Royal Brompton and Harefield Hospitals, Heart Imaging Centre, SW3 6NP London, UK
*Correspondence: (Eirini Lioudaki)
Academic Editors: Zoltán Papp and Ferdinando Carlo Sasso
Rev. Cardiovasc. Med. 2022, 23(3), 82;
Submitted: 15 November 2021 | Revised: 16 December 2021 | Accepted: 11 January 2022 | Published: 3 March 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Sodium-glucose co-transporter (SGLT)-2 inhibitors were initially developed for management of type 2 diabetes but have been shown to offer improved outcomes in heart failure, a condition in which concomitant chronic kidney disease (CKD) is common. Randomised controlled trials initially demonstrated prognostic cardiovascular and renal benefits of SGLT2 inhibitors in high cardiovascular risk individuals with type 2 diabetes particularly in relation to heart failure. Improved outcomes have been replicated in cohorts with established heart failure and/or CKD and appear to extend in those without diabetes. Several specific agents have been considered, with evidence of a class effect, and dapagliflozin and empagliflozin are now incorporated into major international cardiovascular guidelines for management of heart failure with reduced ejection fraction. Beyond glucose lowering effects the mechanisms mediating SGLT2 inhibitors favourable actions are not fully elucidated. Haemodynamic alterations, natriuresis, osmotic diuresis, and weight loss likely contribute to improved outcomes, along with an enhanced cardiometabolic profile. The functional drop in estimated glomerular filtration rate (eGFR) which accompanies SGLT2 inhibitor initiation, before eGFR stabilisation, is likely central in the observed renal benefits. In this review we discuss in detail the evidence for SGLT2 inhibitors in heart failure, particularly with regard to kidney health.

sodium-glucose co-transporter (SGLT)-2 inhibitors
heart failure
chronic kidney disease (CKD)
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