Mar 8, 2023
Chronic kidney disease (CKD) affects millions of people worldwide, and until recently, treatment options have been limited. However, over the past few years, a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as a game-changer in the field of nephrology. Originally designed to treat high blood sugar in people with diabetes, these drugs have been shown to protect the kidneys and reduce the risk of death from cardiovascular disease, the leading cause of death for people with CKD.
For more than two decades, nephrologists had little to offer patients with CKD beyond the standard of care, which included ramping up doses of blood-pressure-lowering drugs and starting the countdown to dialysis. However, SGLT2 inhibitors have completely changed the paradigm. The drugs have given many patients the chance to live dialysis-free for much of their lives, and they have been shown to delay end-stage renal disease and the need for dialysis by up to 15 years.
Over the past few years, trials and observational studies involving tens of thousands of people have reinforced the use of SGLT2 inhibitors outside diabetes. Most recently, the phase III trial called EMPA-KIDNEY showed that the SGLT2 inhibitor called empagliflozin helped to preserve kidney function in people with a wide range of CKD types and severity. These emerging data suggest that SGLT2 inhibitors might improve kidney health even in people who don’t have type 2 diabetes.
Children with CKD could benefit the most from SGLT2 inhibitors, but little is known about their effects in this group. CKD in children is often genetically determined and has no specific drug targets. However, because the inhibitors target mechanisms common to many kidney diseases, they could be a great option for kids. In fact, paediatric nephrologist Petter Bjornstad at Children’s Hospital Colorado prescribes the drugs off-label for adolescents with type 2 diabetes, and he sees clear improvements in markers of kidney function, such as a drop in urine protein levels.
Although SGLT2 inhibitors were first developed as drugs for type 2 and type 1 diabetes, they are no longer approved for the latter in most countries because of an increased risk of ketoacidosis. For most people with type 1 diabetes, the blood-sugar-lowering effects of SGLT2 inhibitors are not worth the risk. However, for people with type 1 diabetes and CKD who are at high risk of end-stage renal disease or cardiovascular diseases, there may be a huge benefit to taking SGLT2 inhibitors.
A layered approach to treatment, such as combining SGLT2 inhibitors with other drugs that block genes involved in kidney-damaging inflammation and fibrosis, is considered safe. However, there are few data on how well these drugs work together, which ones add value and which are redundant. This information is needed so physicians can make the best treatment choices and keep the cost of drugs down.
The emergence of SGLT2 inhibitors as a treatment for CKD represents a major breakthrough in the field of nephrology. By protecting the kidneys and reducing the risk of death from cardiovascular disease, these drugs offer hope to millions of people living with this debilitating condition. As we continue to learn more about these drugs and their potential benefits, it is essential that we work to expand access to them and address concerns about their safety. With ongoing research and clinical trials, we may be able to develop even more effective treatments for CKD, ultimately improving outcomes and quality of life for patients around the world.
Rich Foreman brings over 30 years of technology leadership to his role of CEO and Co-Founder of KidneySoft. As founding CTO, Rich led the team that developed the CordicoShield / CordicoFire Wellness App. Cordico was honored with the Sacramento Innovation Award in 2021. After achieving a 7 digit ARR, Cordico was acquired by Lexipol in 2020. Rich has a BS in Industrial Engineering from the University of Washington, an MPA from Troy State University and was an officer in the U.S. Navy. Rich co-authored his book, "Tap into the Mobile Economy." Rich's blog was listed in Top 20 Marketing Mobile Blogs of 2014. He has been featured on KCRA3, NEWS10, 1170 Tech AM PowerDrive, Business Radio Money 105.5, SiliconIndia, the Sacramento Business Journal, and the Sacramento Bee. Rich is also the Founding Director of the Sacramento Chapter of Startup Grind and served a term as Utility Commissioner for the City of Folsom. Rich is a regular contributor to TechWire.net and StartupSac. Rich was the Co-founder of Apptology which was named Small Business of the Year in 2014 by the Sacramento Asian Pacific Chamber. He was also the Founding Chief Technology Officer at Cordico. Cordico was acquired by Lexipol in 2020. Rich also served 4 years as a Naval Officer in the Civil Engineer Corps.
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