SGLT2 inhibition may improve renal oxygenation
medwireNews: Treatment with the sodium-glucose cotransporter (SGLT)2 inhibitor dapagliflozin produces acute increases in renal oxygenation in people with type 1 diabetes and albuminuria, say researchers.
This may be because SGLT2 inhibition reduces “energy expenditure by inhibition of the oxygen demanding glucose- and sodium cotransport in the renal proximal tubule,” they write in EClinicalMedicine.
The randomized crossover trial involved 15 people, aged an average of 58 years with type 1 diabetes lasting an average of 39 years, who received two doses of dapagliflozin 50 mg or placebo, in a randomly assigned order with a 2-week washout period between each intervention.
During the 6 hours after the intervention, renal cortical oxygenation, which was measured using magnetic resonance imaging, significantly improved with dapagliflozin versus placebo. There was also a nonsignificant improvement in renal medullary oxygenation and a transient nonsignificant reduction in renal blood flow.
Of note, the researchers report a large, significant difference in baseline cortical oxygenation between the 20% of participants who had macroalbuminuria and the 80% with microalbuminuria, with the reduced oxygenation in the former group “indicating severe tissue hypoxia.”
Jens Christian Laursen (Steno Diabetes Center Copenhagen, Denmark) and team say that they opted to study people with type 1 diabetes “as a more direct model of diabetic kidney disease” than with type 2 diabetes, where a variety of mechanisms can contribute to renal dysfunction.
They caution that “it remains to be determined whether the observed effects can be achieved with lower doses, with chronic treatment and if they occur in type 2 diabetes as well.”
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