Inhibidores de la SLGT-2 en el manejo de enfermedad renal crónica en pacientes no diabéticos
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Introducción: la enfermedad renal crónica (ERC) es una de las entidades con mayor prevalencia y se proyecta que en el futuro sea una de las principales causas de enfermedades crónicas. Hasta hace un par de décadas, el único tratamiento conocido para modificar su curso eran los inhibidores del sistema renina-angiotensina. Sin embargo, las nuevas terapias como los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSLGT-2) se han convertido en la piedra angular del tratamiento de esta entidad tanto en pacientes diabéticos como no diabéticos, debido a su efecto protector sobre la función renal y cardiovascular.
Estado del arte: los iSLGT-2 son fármacos que reducen la reabsorción renal de glucosa, generando glucosuria. Además, disminuyen la presión intraglomerular, protegiendo al riñón del daño asociado con la hiperglucemia y provocan natriuresis, lo que reduce el volumen plasmático y la presión arterial. Varios estudios han demostrado su eficacia para prevenir o retrasar el deterioro renal, la mortalidad cardiovascular, las hospitalizaciones y la insuficiencia cardíaca (IC), mejorando la calidad de vida en algunos pacientes. Sin embargo, los efectos protectores no son consistentes en pacientes con accidente cerebrovascular (ACV).
Conclusión: hasta la fecha, los iSLGT-2 son el tratamiento más eficaz para retrasar la progresión de la ERC. Sus beneficios han mostrado ser consistentes en diversos subgrupos particularmente en pacientes con ERC con proteinuria, tanto en aquellos diabéticos como no diabéticos, según ensayos clínicos y metanálisis.
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