Nephroprotective properties of glucose-lowering drugs

Diabetic nephropathy is one of microvascular complications of diabetes mellitus, which is the leading cause of end-stage renal disease, requiring renal replacement therapy (dialysis, kidney transplantation). The quality and life expectancy of patients on dialysis is very low, and treatment requires significant material costs, therefore, a high priority is accorded to the prevention of the development and the progression of diabetic nephropathy. Primary prophylaxis is aimed at maintaining the target level of glycemia and glycated hemoglobin, blood pressure, lipid spectrum, for the secondary prevention, in addition to the above-mentioned indicators, drugs from RAAS blockers group are used. Also, in recent years, several classes of new glucose-lowering drugs (iSGLT-2, aGLP-1, iDPP-4) have appeared, affecting not only glycemia and metabolic parameters, but also renal function. In this review, we analyzed the results of large-scale international randomized trials designed to assess the nephroprotective properties of glucose-lowering drugs from the iSGLT-2, aGLP-1 and iDPP-4 groups. In studies with iSGLT-2 group, it is possible to speak of a class effect on the reduction of cardiovascular and renal risks and recommend their use for proven CVD and CKD. In the group of incretin drugs, one may infer, that they are cardiovascular safe, and in some studies, a positive effect on renal function in the form of reduced AU has been shown. Based on the data obtained, there is great interest in the study of the direct nephroprotective effect of these drugs, which may have a fundamental role in preventing the development and the progression of diabetic nephropathy.