Abstract：
Inhibitors of sodium glucose co-transporter type 2 (iSGLT2) constitute a considerable advance in the management of patients with diabetes, heart failure and with chronic kidney disease (CKD). Randomized controlled studies have shown a significant reduction of cardiovascular risk in diabetic type 2 and/or heart failure with reduced ejection fraction patients. These studies observed a risk reduction of worsening nephropathy, leading to randomized controlled studies in CKD patients : CREDENCE, DAPA-CKD and EMPA-KIDNEY. iSGLT2 are associated with a slower progression toward end-stage kidney disease, a lower slope of GFR and a lower rate of albuminuria. In CKD patients with proteinuria either diabetic or not, the DAPA-CKD and the EMPA-KIDNEY studies have demonstrated a nephroprotective effect. This effect has not been found for patients without proteinuria. For the other nephropathies, further studies are required to confirm results obtained in patients without type 2 diabetes and macroalbuminuria. Therefore, the indication of iSGLT2, with appropriate dose of RAS inhibitor, seems undeniable to an optimal nephroprotection in CKD patients with type 2 diabetes and/or albuminuria and/or heart failure. They must be prescribed in addition to conventional nephroprotective and cardioprotective treatments and care. Side effects are limited. However, special education and monitoring concerning risks of genital infection and euglycemic ketoacidosis (diabetic patients) must be taken in mind. The therapeutic arsenal for CKD patients is expanding, leading to consider a personalized care according to the underlying nephropathy. © 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.
摘要：
2型钠葡萄糖协同转运蛋白（iSGLT2）的抑制剂在糖尿病患者的管理方面取得了重大进展，心力衰竭和慢性肾病（CKD）。随机对照研究表明，射血分数降低的2型糖尿病和/或心力衰竭患者的心血管风险显着降低。这些研究观察到肾病恶化的风险降低，导致CKD患者的随机对照研究：CREDENCE，DAPA-CKD和EMPA-KIDNEY.iSGLT2与终末期肾病进展缓慢相关，GFR斜率较低，白蛋白尿发生率较低。在患有蛋白尿的CKD患者中，无论是否患有糖尿病，DAPA-CKD和EMPA-KIDNEY研究已证明具有肾保护作用.对于没有蛋白尿的患者尚未发现这种作用。对于其他肾病，需要进一步的研究来证实在没有2型糖尿病和大量白蛋白尿的患者中获得的结果.因此,iSGLT2的适应症，加上适当剂量的RAS抑制剂，对于患有2型糖尿病和/或蛋白尿和/或心力衰竭的CKD患者的最佳肾保护似乎是不可否认的。除了常规的肾保护和心脏保护治疗和护理外，还必须开处方。副作用有限。然而,必须牢记有关生殖器感染和正常血糖酮症酸中毒（糖尿病患者）风险的特殊教育和监测。CKD患者的治疗库正在扩大，导致根据潜在的肾病考虑个性化护理。©2022由ElsevierMassonSAS代表法国法语国家集团发布，透析et移植。
