肾脏病学与治疗学杂志

Differentiating Sodium-Glucose Cotransporter 2 Inhibitors from Live Biotherapeutic Products (Probiotics) as Novel Therapeutic Intervention to Slow CKD Progression

Abstract

Emmanuel Anteyi* and Natarajan Ranganathan

Chronic kidney disease (CKD) is a global public health problem with high morbidity and mortality, from cardiovascular complications. CKD is a progressive and irreversible deterioration of kidney function with complex pathophysiological and pathogenetic pathways due to diverse etiologies and risk factors. Progression of CKD has a common complex and interrelated immunological and metabolic pathway resulting in inflammation and oxidative stress processes. This progression manifests clinically as irreversible functional and structural damage. The primary aim of therapeutic intervention in CKD management is delay progressive loss of function, and to prevent and manage complications. Recent approaches to slowing CKD progression include therapy with sodium-glucose cotransporter 2 inhibitor (SGLT2) and gut microbiome modulation with probiotics, based on beneficial clinical outcomes of metabolic, immunological, inflammatory, and hemodynamic changes associated with CKD progression. Despite comparable mechanisms of action in slowing CKD progression, these two classes of medications differ in their safety profile, treatment effect on CKD stages, and patient population group. The focus of this review is how to differentiate SGLT2 from probiotics as novel therapeutic agents targeting CKD progression from the perspective of CKD severity, patient group and safety profile. This may be a valuable guide for future strategic planning and decision making in clinical development programs of therapeutic interventions in CKD progression.