Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors

Type 2 diabetes is the single most important cause of End-Stage Kidney Disease. No significant progress in the field has been made since the landmark trials of renin-angiotensin system inhibitors (RASi) in the early 2000s. The recent introduction of sodium-glucose cotransporter-2 inhibitors reversed 20 years of stagnation in this area, leading to clinically meaningful improvements in overall and cardiovascular survival, worsening kidney function, need for dialysis, and heart failure events. This review will summarize key findings from the landmark cardiovascular safety, heart failure, and kidney disease with these agents. The basic pharmacology, mechanisms of action, adverse events, and pharmacological profile of agents approved for human use are presented in a concise fashion, and directions are given for the successful clinical use of these agents in patients with type 2 diabetes as well as the recipients of kidney transplants with diabetes.