RECENT APPROVAL of dapagliflozin for the treatment of chronic kidney disease (CKD) has been confirmed by the National Institute of Health and Social Care Excellence (NICE). The drug is a form of sodium-glucose co-transporter-2 (SGLT2) inhibitor, which have been used to treat Type 2 diabetes since 2013 and have recently been found to have protective effects on the kidney, delaying CKD progression in both diabetic and non-diabetic patients as well as lowering the risk of heart attacks.
SGLT2 inhibitors are an effective means of treating Type 2 diabetes through utilising mechanisms that aid the kidneys in lowering blood glucose levels. Taken once daily, these drugs facilitate an increase in the excretion of glucose via the urine. Current guidance suggests that treatment with dapagliflozin will be made available for patients with broad kidney impairment and protein leaking into their urine, both with and without Type 2 diabetes. This includes patients with an estimated glomerular filtration rate of 25–75 mL/min/1.73 m2. Dapagliflozin will be offered as one of the best current treatments, alongside angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; however, it will not be an option for transplant patients.
Fiona Loud, Policy Director, Kidney Care UK, explained: “Slowing down kidney disease can be life-changing for people with CKD, and we hope that these new treatments are offered alongside diet, exercise, and lifestyle support and advice.” Guidelines on the use of SGLT2 inhibitors to treat CKD are due to be published in the coming weeks. While promising, kidney specialist and Kidney Care UK Trustee Graham Lipkin stressed the importance of discussing the potential side effects of the treatment with patients: “Whilst the reported side effects are favourable, these drugs require careful monitoring. Once NICE guidance is released, we must work with patients and other healthcare professionals to ensure that all who may benefit from SGLT2 inhibitors have access to them.”