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J. Clin. Med. 2015, 4(10), 1866-1889; doi:10.3390/jcm4101866

Nephroprotection by Hypoglycemic Agents: Do We Have Supporting Data?

1
Hospital Universitario Dr Peset, Universidad de Valencia, Valencia 46017, Spain
2
Hospital General Universitario de Ciudad Real, Ciudad Real, 13005 Ciudad Real, Spain
3
Hospital Universitario N S Candelaria, Tenerife 38010, Spain
4
Hospital Universitario Bellvitge, IDIBELL, Barcelona 08907, Spain
5
GEENDIAB, Diabetic Nephropathy Working Group of the Spanish Society of Nephrology, Spain
6
Carlos III Research Institute, Madrid 28029, Spain
*
Author to whom correspondence should be addressed.
Academic Editor: Jane Grant-Kels
Received: 11 July 2015 / Revised: 20 August 2015 / Accepted: 25 August 2015 / Published: 23 October 2015
(This article belongs to the Special Issue Diabetic Nephropathy)
View Full-Text   |   Download PDF [206 KB, uploaded 27 October 2015]

Abstract

Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, renin angiotensin-aldosterone system blockade and multifactorial intervention. However, the renal protection provided by these therapeutic modalities is incomplete. There is a scarcity of studies analysing the nephroprotective effect of antihyperglycaemic drugs beyond their glucose lowering effect and improved glycaemic control on the prevention and progression of diabetic nephropathy. This article analyzes the exisiting data about older and newer drugs as well as the mechanisms associated with hypoglycemic drugs, apart from their well known blood glucose lowering effect, in the prevention and progression of diabetic nephropathy. Most of them have been tested in humans, but with varying degrees of success. Although experimental data about most of antihyperglycemic drugs has shown a beneficial effect in kidney parameters, there is a lack of clinical trials that clearly prove these beneficial effects. The key question, however, is whether antihyperglycemic drugs are able to improve renal end-points beyond their antihyperglycemic effect. Existing experimental data are post hoc studies from clinical trials, and supportive of the potential renal-protective role of some of them, especially in the cases of dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors. Dedicated and adequately powered renal trials with renal outcomes are neccessary to assess the nephrotection of antihyperglycaemic drugs beyond the control of hyperglycaemia. View Full-Text
Keywords: diabetes mellitus; diabetic nephropathy; diabetic chronic kidney disease; albuminuria; nephroprotection; antihyperglycemic drugs; SGLT2 inhibition; albuminuria; DDP4 inhibitors; glucagon-like peptide agonists diabetes mellitus; diabetic nephropathy; diabetic chronic kidney disease; albuminuria; nephroprotection; antihyperglycemic drugs; SGLT2 inhibition; albuminuria; DDP4 inhibitors; glucagon-like peptide agonists
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Górriz, J.L.; Nieto, J.; Navarro-González, J.F.; Molina, P.; Martínez-Castelao, A.; Pallardó, L.M. Nephroprotection by Hypoglycemic Agents: Do We Have Supporting Data? J. Clin. Med. 2015, 4, 1866-1889.

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