Abstract：
OBJECTIVE: Chronic kidney disease and end-stage kidney disease (ESKD) are well-established risk factors for cardiovascular disease (CVD), the leading cause of mortality in the dialysis population. Conventional therapies, such as statins, blood pressure control, and renin-angiotensin-aldosterone system blockade, have inadequately addressed this cardiovascular risk, highlighting the unmet need for effective treatment strategies. Sodium-glucose transporter 2 (SGLT2) inhibitors have demonstrated significant renal and cardiovascular benefits among patients with type 2 diabetes, heart failure, or CKD at risk of progression. Unfortunately, efficacy data in dialysis patients is lacking as ESKD was an exclusion criterion for all major clinical trials of SGLT2 inhibitors. This review explores the potential of SGLT2 inhibitors in improving cardiovascular outcomes among patients with ESKD, focusing on their direct cardiac effects.
RESULTS: Recent clinical and preclinical studies have shown promising data for the application of SGLT2 inhibitors to the dialysis population. SGLT2 inhibitors may provide cardiovascular benefits to dialysis patients, not only indirectly by preserving the remaining kidney function and improving anemia but also directly by lowering intracellular sodium and calcium levels, reducing inflammation, regulating autophagy, and alleviating oxidative stress and endoplasmic reticulum stress within cardiomyocytes and endothelial cells. This review examines the current clinical evidence and experimental data supporting the use of SGLT2 inhibitors, discusses its potential safety concerns, and outlines ongoing clinical trials in the dialysis population. Further research is needed to evaluate the safety and effectiveness of SGLT2 inhibitor use among patients with ESKD.
RESULTS: Recent clinical and preclinical studies have shown promising data for the application of SGLT2 inhibitors to the dialysis population. SGLT2 inhibitors may provide cardiovascular benefits to dialysis patients, not only indirectly by preserving the remaining kidney function and improving anemia but also directly by lowering intracellular sodium and calcium levels, reducing inflammation, regulating autophagy, and alleviating oxidative stress and endoplasmic reticulum stress within cardiomyocytes and endothelial cells. This review examines the current clinical evidence and experimental data supporting the use of SGLT2 inhibitors, discusses its potential safety concerns, and outlines ongoing clinical trials in the dialysis population. Further research is needed to evaluate the safety and effectiveness of SGLT2 inhibitor use among patients with ESKD.
摘要：
目的：慢性肾脏病和终末期肾脏病（ESKD）是心血管疾病（CVD）的公认危险因素，透析人群死亡的主要原因。常规疗法,如他汀类药物，血压控制,肾素-血管紧张素-醛固酮系统阻断，没有充分解决这种心血管风险，强调对有效治疗策略的未满足需求。钠-葡萄糖转运蛋白2（SGLT2）抑制剂在2型糖尿病患者中表现出显著的肾脏和心血管益处。心力衰竭,或CKD有进展的风险。不幸的是,透析患者的疗效数据缺乏,因为ESKD是SGLT2抑制剂所有主要临床试验的排除标准.这篇综述探讨了SGLT2抑制剂在改善ESKD患者心血管预后方面的潜力。关注它们的直接心脏效应.
结果：最近的临床和临床前研究显示了SGLT2抑制剂应用于透析人群的有希望的数据。SGLT2抑制剂可能为透析患者提供心血管益处，不仅间接通过保持剩余的肾功能和改善贫血，而且直接通过降低细胞内钠和钙水平，减少炎症，调节自噬，减轻心肌细胞和内皮细胞内的氧化应激和内质网应激。这篇综述审查了当前支持使用SGLT2抑制剂的临床证据和实验数据。讨论其潜在的安全问题，并概述了透析人群中正在进行的临床试验。需要进一步的研究来评估SGLT2抑制剂在ESKD患者中使用的安全性和有效性。
结果：最近的临床和临床前研究显示了SGLT2抑制剂应用于透析人群的有希望的数据。SGLT2抑制剂可能为透析患者提供心血管益处，不仅间接通过保持剩余的肾功能和改善贫血，而且直接通过降低细胞内钠和钙水平，减少炎症，调节自噬，减轻心肌细胞和内皮细胞内的氧化应激和内质网应激。这篇综述审查了当前支持使用SGLT2抑制剂的临床证据和实验数据。讨论其潜在的安全问题，并概述了透析人群中正在进行的临床试验。需要进一步的研究来评估SGLT2抑制剂在ESKD患者中使用的安全性和有效性。
