Impact of Sodium-Glucose Cotransporter-2 Inhibitors in the Management of Chronic Kidney Disease: A Middle East and Africa Perspective

Abstract

Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to their cardioprotective properties and complementary mechanisms of action. In this review, we present guideline-based consensus recommendations by experts from the MEA region, as practical algorithms for screening, early detection, nephrology referral, and treatment pathways for CKD management in patients with hypertension and diabetes mellitus. This study will help physicians take timely and appropriate actions to provide better care to patients with CKD or those at high risk of CKD.

Keywords:

• chronic kidney disease
• nephrology referral
• screening
• sodium-glucose cotransporter-2 inhibitors

Acknowledgments

The authors would like to thank Dr. Dakshayani S and Dr. Soma Santra of Fortrea Scientific Pvt. Ltd. (formerly Labcorp Scientific Services & Solutions Pvt. Ltd) for medical writing support, which was funded by AstraZeneca FZ LLC in accordance with the Good Publication Practice 2022 guidelines.

Author Contributions

Ahmed Fathi ElKeraie conceptualized this study. All authors contributed equally to the literature review and the preparation of the first draft of the manuscript. All the authors contributed equally to study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, reviewing and editing the manuscript. All the authors have read and approved the final version of the manuscript to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Ahmed Fathi ElKeraie received speaker honoraria from AstraZeneca, Novartis, Boehringer Ingelheim, Sanofi, Johnson and Johnson, Amgen, Roche, Astellas Pharma, Inc., and Fresenius Kabi. Saeed Al-Ghamdi received speaker honoraria from AstraZeneca, Astellas Pharma Inc., AbbVie, and Vifor Pharmaceuticals. Ali K Abu-Alfa received speaking and consulting honoraria and/or research support from Astellas Pharma Inc., AstraZeneca, Baxter Healthcare, Boehringer Ingelheim, Fresenius Medical Care, Novartis and Sanofi-Aventis. His contribution to this publication was made in his individual capacity and not as part of his American University of Beirut or any other organization or institution duties or responsibilities. Mustafa Arici received speaker honoraria from Amgen, Astellas Pharma Inc., AstraZeneca, Bayer, Boehringer Ingelheim, Menarini, MSD, Novo Nordisk, Sandoz and Sanofi. He also received honoraria as an advisory board member for Astellas Pharma Inc., AstraZeneca, Bayer, Boehringer Ingelheim, MSD, and Novo Nordisk. Tevfik Ecder received speaker honoraria from Amgen, Astellas Pharma Inc., AstraZeneca, Bayer, Boehringer Ingelheim, Menarini, Recordati, Sandoz and Sanofi. The authors report no other conflicts of interest in this work.

Additional information

Funding

The preparation of this consensus manuscript and funding of the journal’s article processing charges were supported by AstraZeneca FZ, LLC. All authors had full access to all the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analyses.