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GLP-1 receptor agonists and SGLT2 inhibitors: a couple at last?

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  • Renoprotective effects of sodium-glucose cotransporter-2 inhibitors

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    Of course, as with any glucose-lowering medication, the advantages, side-effect profiles, and costs should be considered to tailor individualized therapy, as discussed in the following. For combination therapies and kidney protection, SGLT2 inhibitors and GLP1RA agents may be used together due to their different and unique mechanisms of action for both glycemic and nonglycemic effects.115 Moreover, it is likely that these 2 classes reduce albuminuria via different mechanisms, with SGLT2 inhibitors acting on predominant hemodynamic pathways and glucagon-like peptide-1 receptors agonists (GLP1RAs) via nonhemodynamic anti-inflammatory and oxidant mechanisms.

  • Novel therapies for diabetic kidney disease

    2018, Kidney International Supplements
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    Third, among the glucose-lowering agents, SGLT2is lead to a proximal natriuresis, as described above. GLP-1 RAs and DPP-4 inhibitors, on the other hand, induce natriuretic effects through proximal and distal mechanisms, respectively, which may lead to additive plasma volume depletion when used in combination.86 Further benefits may result from additive effects on HbA1c, weight reduction, and blood pressure lowering, as shown in the Exenatide Once Weekly Plus Dapagliflozin Once Daily Versus Exenatide or Dapagliflozin Alone in Patients With Type 2 Diabetes Inadequately Controlled With Metformin Monotherapy (DURATION-8) trial, leading to further potential renal and cardiovascular protection.87

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