start SGLT2 inhibitos in CKD patients with proteinuria

Patients with chronic kidney disease (CKD) should receive treatment for the underlying cause of the renal disease, such as blood pressure medications (eg, hypertensive nephrosclerosis) and glycemic control (eg, diabetic nephropathy).  Those with proteinuric CKD should receive additional medications that have been shown to slow progression of renal disease regardless of underlying cause.

The following medications exert a renal protective effect (independent of blood pressure and glycemic control) by reducing glomerular hyperfiltration:

SGLT-2 inhibitors reduce glucose and sodium reabsorption in the proximal tubule.  In addition to decreasing serum glucose and blood pressure, these medications reduce glomerular hyperfiltration by restoring tubuloglomerular feedback mechanisms that are disrupted in CKD (regardless of cause).  Dapagliflozin specifically has been shown to reduce proteinuria and slow the progression of renal disease in both diabetic and nondiabetic patients with proteinuric CKD.

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