The Singapore Family Physician

Back to issue Vol 47 No. 8 - Updates in DM and CKD management: Are SGLT2 Inhibitors the answer?

Acting on the Latest SGLT2i Evidence to Treat CKD Patients in Primary Care

Teo Boon Wee Jimmy
The Singapore Family Physician Vol 47 No 8 - Updates in DM and CKD management: Are SGLT2 Inhibitors the answer?
9 - 12
2 October 2021
0377-5305
The prevalence of Chronic Kidney Disease (CKD) is increasing due to an ageing Singapore population and increasing prevalence of risk factors of hypertension and diabetes. Screening using serum creatinine and urine albumin to creatinine will detect and classify CKD. This allows interventions for the retardation of kidney function decline, and the prevention of the complications of CKD including end-stage kidney disease (ESKD), anaemia, mineral bone disorder, and death. Besides the optimal use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) in both diabetic and non-diabetic CKD, sodium-glucose cotransporter type 2 inhibitors (SGLT2i) were identified to retard CKD, prevent ESKD, and death. More recent studies suggest that regardless of the degree of albuminuria or degree of glycated haemoglobin, SGLT2i improve the outcomes of CKD patients. Moreover, SGLT2i can be started with an estimated glomerular filtration rate as low as 20 mL per minute per 1.73 m2 body surface area. As nephron loss is irreversible, aggressive control of risk factors to goals and using the kidney protective medications of ACE-I, ARB, and SGLT2i are crucial in the remission of early CKD.