Muthiah Vaduganathan, MD: SGLT2 Inhibitors in Patients with Severe Renal Impairment


A cardiologist from Brigham and Women's Hospital discusses prescribing SGLT2 inhibitors to patients with an EGFR approaching or below 30.

Few drug classes, if any, have captured and held the attention of specialists the way SGLT2 inhibitors have in the last half of the decade. Once an antidiabetic agent known for milder weight loss and HbA1c reductions than their counterparts in the GLP-1 receptor agonist class, SGLT2 inhibitors are now receiving recognition for the cardiorenal benefits they have been proven to provide in major clinical trials presented in recent years.

As a result of this, major organizations across different fields have adjusted guidelines or released guidance related to the agents. In a recent scientific statement, the American Heart Association outlined the impact of these agents in recent trials and related how this information can be applied to patient populations in real-world settings. A member of the writing committee for the statement, Muthiah Vaduganathan, MD, MPH, was tasked with aggregating information and providing perspective on a topic that is evolving faster than any could have imagined just a short time ago. In the time that has elapsed since the committee began writing until the release of the statement, 3 outcomes trials were presented at international meetings.

Among these trials was DAPA-CKD, a much anticipated renal outcomes trial, which headlined ESC 2020 almost one year to the date after DAPA-HF was presented at ESC 2019. Data from this trial, along with those from previous studies examining renal outcomes, have strengthened the notion the cardiorenal benefits seen in earlier trials are truly a class effect.

Still, many early trials, and those focusing on cardiovascular outcomes, had a EGFR cutoff of 30 ml/min/1.73 m2. As a result, prescribing for patients with an EGFR approaching or below the 30 ml/min/1.73 m2 cutoff has been a subject of debate among some clinicians. As part of a recent interview, we asked Vaduganathan how the committee adapted to this research timeline and when he thinks prescribing these agents is appropriate for a patient with more severe renal impairment.

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