Kidney hemodynamic effects of sodium-glucose cotransporter 2 inhibitors in diabetes: physiology and clinical implications
León-Jiménez D, Sridhar VS, López-Mendoza M, Scholtes RA, Schmieder R, Cherney DZ, van Raalte DH, Toro-Prieto FJ, Miramontes-González JP, van Bommel EJ (2025)
Publication Type: Journal article, Review article
Publication year: 2025
Journal
Book Volume: 18
Article Number: sfae370
Journal Issue: 1
DOI: 10.1093/ckj/sfae370
Abstract
The progressive loss of kidney function in diabetes mellitus is partly attributable to the occurrence of glomerular hyperfiltration. Consequently, therapeutic interventions that lower intra-glomerular pressure are a cornerstone of treatment in diabetic kidney disease. Sodium-glucose cotransporter 2 (SGLT2) inhibitors consistently reduce glomerular filtration rate (GFR) and calculated intraglomerular pressures across studies. However, the net effect on arteriolar tone that leads to acute GFR declines may differ between cohorts. While pre-glomerular vasoconstriction appears to be the dominant mechanism responsible for GFR dipping in patients with type 1 diabetes (T1D) and glomerular hyperfiltration, other factors, including post-glomerular vasodilation, may contribute to the acute GFR decline in normofilterering individuals with T1D and type 2 diabetes. Regardless of the responsible mechanisms, acute changes in GFR are associated with long-term kidney function preservation—a relationship that may reflect an underlying protective decline in glomerular hypertension.
Authors with CRIS profile
Involved external institutions
Hospitales Universitarios Virgen Macarena y Virgen del Rocío
Spain (ES)
Hospital Universitario Rio Hortega
Spain (ES)
Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra
Netherlands (NL)
University Health Network (UHN)
Canada (CA)
Spain (ES)
Hospital Universitario Rio Hortega
Spain (ES)
Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra
Netherlands (NL)
University Health Network (UHN)
Canada (CA)
How to cite
APA:
León-Jiménez, D., Sridhar, V.S., López-Mendoza, M., Scholtes, R.A., Schmieder, R., Cherney, D.Z.,... van Bommel, E.J. (2025). Kidney hemodynamic effects of sodium-glucose cotransporter 2 inhibitors in diabetes: physiology and clinical implications. Clinical Kidney Journal, 18(1). https://doi.org/10.1093/ckj/sfae370
MLA:
León-Jiménez, David, et al. "Kidney hemodynamic effects of sodium-glucose cotransporter 2 inhibitors in diabetes: physiology and clinical implications." Clinical Kidney Journal 18.1 (2025).
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