The development of chronic kidney disease (CKD) is a risk factor not only for cardiovascular diseases, but also for heart failure (HF). This article is a literary review on the use of Sodium-glucose co-transporter-2 (NGLT2) inhibitors in patients with CKD and HF. The paper describes in detail the action of NGLT2 inhibitors in the light of nephro- and cardioprotection. In addition to the glucosuric effect of NGLT2 inhibitors, they have a natriuretic and diuretic effect. One of the effects of NGLT2 inhibitors is the ability to lower blood pressure. One of the key effects of NGLT2 inhibitors, explaining nephroprotection, is the influence on glomerular filtration. The ability of NGLT2 inhibitors to suppress the peroxidation in mitochondria of proximal tubular epithelium was shown. Another putative mechanism of the organ protection action of NGLT2 inhibitors is their ability to inhibit the activation of the sympathetic nervous system.The results of studies using empagliflozin in HF and CKD are presented. In particular, the EMPA-REG OUTCOME study showed that in patients with type 2 diabetes and concomitant cardiovascular diseases, empagliflozin led to a 35% decrease in hospitalization risk due to decompensated HF and decrease of cardiovascular death risk by 38% regardless of baseline renal function. According to the EMPEROR-Reduced study, empagliflozin showed a favorable safety profile.
Expert Panel Recommendations for the Identification and Management of Hyperkalemia and Role of Patiromer in Patients with Chronic Kidney Disease and Heart Failure