How SGLT2 Inhibitors Protect The Kidney

I share my understanding of how this exciting class of medications helps protect the kidney in CKD. It's very interesting and is a great review of glomerular autoregulation / tubuloglomerular feedback!
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[@lajoszsommd1526]

Senior nephrologist here: wonderful lecture, I used to teach residents exactly like this. Problem: glomerular hypertension and resultant proteinuria is a major theme here, yet even with ACEI or SGLT-2i, proteinuria is often ignored as a therapeutic target even in major studies. On the other hand, low eGFR with its major drawbacks and imprecision is substituted for all other clinical and individual markers of kidney disease as if CKD was nothing beyond "low eGFR disease". So instead of global individual assessment, we have partial statistical assessment on the population level. Do you see my frustration?

[@Alyssa_M513]

Thank you so much for posting this video, it was the perfect amount of detail for me. I am a pharmacist who graduated in 2017 and I really needed this refresher.

[@ashishshirsatmumbai6706]

Thank you for simplifying the topic!

[@totolundy]

I’m a resident at Mayo! Super helpful. Keep it up!

[@debigdogk9563]

Great job . Always very educational and helpful. Thank you ❤❤❤❤❤❤❤

[@tanyaalexander9387]

Excellent, thank you!

[@humeyraer5649]

thanks so much. this video was the one i needed.

[@donnasimpson8703]

Fabulous! Thank you so much...

[@kapteklanning]

Great talk and solid explanation.

[@youtuber1650]

The most stringent parameter in our body is osmolarity. Glucose is osmolaric effective which means that it's not that simple. Besides, bacteria love glucose. Again, it's not that simple. SGLT inhibitors may have its indication but it must be more closely defined. I had quite a few patients on my ward because of them.

[@24bit192khtz]

Well explained!

[@baldogtondo7017]

thank you very much, now we understand..

[@yetian6919]

man, thank you soooo much

[@mortalmedicine]

You remind me of a resident that taught me many mechanisms during my internal rotations! I can imagine it being a blast to work with you. Do you plan on building your own clinic in the future?

[@daemoncan2364]

Great explanation (even for a layperson audience). Excellent explanation of the maladaptive reaction to increased glucose & sodium in the filtrate (Similar concept to remodeling in HF).

[@shinn-tyanwu4155]

Outstanding 😊😊

[@westfield90]

Superb explanation. Are you able to do a video on how this same med helps with heart failure

[@aarons2635]

Thanks for this video Conan, watched it as a refresher on how SGLT2is work- What are your thoughts on SGLT2i being constantly pushed to the limit in terms of renal function? Results of recent studies highlight its enduring efficacy despite declining renal function, and with future SGLT2i studies in dialysis patients, seems counterintuitive for a drug that needs to be filtered for it to work in the first place- seems like there might be more to SGLT2is than we originally thought!

[@xBlakeH]

Hello Dr. Liu, Could you please make a video on the step-by-step process of pre-charting on patient that was admitted overnight (or an unfamiliar patient being transferred to your care)? As a student, I find this to be the most time-consuming process and often get bogged down in the details. This is especially the case when the patient has been on the service for several days and has tons of progress notes, consults notes, and imaging to sift through. Also, more generally, how do you pre-chart efficiently in the AM? Do you recommend using a data tracker sheet like OME suggests? Thank you very much. Your videos have been very helpful!

[@jingcliu]

Can you talk about the mechanism of euglycemic dka? It's one of the main issues we deal with in the ED regarding these meds

[@ian2lorimer]

This is really interesting. I've been taking Metformin for a few years and my egfr score has recently dropped to under

[@ConanLiuMD]

Yeah, generally we stop metformin with eGFR drops below 30. And it doesn't have the renal protective effects that SGLT2 inhibitors have - but, that being said we do still consider it our first line medication for diabetes since it is so well tolerated with minimal side effects. So I don't think your doctor was wrong at all to have you on it! Generally we start with metformin -> add SGLT2 inhibitor or GLP-1 agonist as a second step!

[@jbbotha]

Well explained thank you

[@smokinghazards123]

Amazing video. Thanks for such detail lesson. Among the 2, Dapaglifazon and Empaglifazon, which one is better for initial stage renal patients with egfr around 40 and creatinine around 1.7, 1.2 being normal? Also, are SGLT2 Inhibitors better than Gliptins like Linagliptin among ckd patients?

[@dennischan7598]

Thank you for the Awesome video Dr Liu. Does the GFR reverse when they discontinue the SGLT2 inhibitors? What’s your suggestion for Type 1 diabetic patients?

[@ConanLiuMD]

Type 1 diabetics will typically need insulin! GFR probably will transiently improve after stopping SGLT2 inhibitors, but you will lose the renal protection aspect

[@dennischan7598]

@@ConanLiuMD Thank you for getting back to me Dr. Liu. I use a combination of insulin a SGLT2 inhibitors for my Type 1

[@alikhalid4688]

can you make a video on how SGLT2 inhibitors help in heart failure?

[@mayoczel07]

how protein being able to be filtered?

[@thomasschock4799]

Can you make a video on how to accurately test the eGFR of a athlete/active person? Nobody seems to ever talk about a Cystatin-C test.

[@ConanLiuMD]

Hmm I’m not sure how much I would have to add other than cystatin C is becoming more and more favored since it isn’t affected by muscle mass! It’s a great point you brought up. It’s also particularly helpful in elderly frail patients who have super low muscle mass too

[@smokinghazards123]

Hi there. I have read this cant be given to patients having gfr below 45. In that case, doesn’t it contradicts its renal protective claim?

[@CaptRajuseriousflightsimmer]

Thank you so much for the thorough explanation, my question is does everyone have some decrease of eGFR when taking SGLT2 Because one of my friend his eGFR didn't affect while taking the medication, I heard even its drop for some people instance but later eGFR is back to normal is it true? my eGFR 72. I'm a little worried about taking the medication.

[@ConanLiuMD]

Yes you should expect some decrease in eGFR when starting an SGLT2 inhibitor, but the benefits for kidney protection outweigh that initial change!

[@user-ym1sj3bl6p]

Hi doc! Would you recommend forxiga 10 with trandolapril(ace inhibitors) for 24 year old male with proteinuria, isolated systolic hypertension and glomerular hyperfiltration, no diabetes, normal blood levels, >90 GFR. I have for the past 5 years been on a control of blood pressure and proteinuria , but my doctor says without kidney biopsy they cant know much , other than it is good to consume ace inhibitors and recently they added to it forxiga 10mg "for kidney protection". Thanks!

[@ConanLiuMD]

Hmm, I don't know if we have very strong recommendations/guidelines yet for this patient population. I'd probably have to defer to your nephrologist to see if it would be recommended. This video does hopefully provide a nice explanation for how it might be beneficial however

[@ihsanclips]

Please do genetic testing, I am non diabetic, hypertension with proteinurea, later found out with genetic testing of Alport syndrome

[@donnasimpson8703]

Is there a preference for one SGLT-2 I over another for ...eg HF, CKD, comorbidity of all, some, disease state? and of course diabetes.)😊

[@ConanLiuMD]

Not too much, it kind of just depends on what the hospital or physician is used to! We use empagliflozin or Jardiance the most here

[@donnasimpson8703]

@@ConanLiuMD rhank you doe taking the time to reply. I am in Australia and also the same two, dapag for CHF

[@WonderMagicStories]

Can a stage 4 cdk patients take this medicine

[@ConanLiuMD]

Empagliflozin has been shown to continue to be beneficial in patients with GFR as low as 20. Below that and we usually don't prescribe it. CKD4 includes GFR ranging from 15-30 so a subset of patients would still qualify!

[@yeonheebuehler9140]

Can I take SGLT 2 for my CKD 1 without diabetes?

[@ConanLiuMD]

I have not seen many providers treating CKD1 as we essentially consider this normal kidney function - but I would ask your own doctor.

[@ThatsWhy-]

No. Why? Because in hypoglycemia , the high insulin is inhibiting SGLT !