{"id":"62f4f9326dc5","type":"article","url":"https://hartvaat.nl/2020/01/01/renale-hemodynamische-effecten-van-dapagliflozine-postglomerulaire-vasodilatatie/","title":"Renale hemodynamische effecten van dapagliflozine: postglomerulaire vasodilatatie","title_en":"The renal hemodynamic effects of the SGLT2 inhibitor dapagliflozin are caused by post-glomerular vasodilatation rather than pre-glomerular vasoconstriction in metformin-treated patients with type 2 diabetes in the randomized, double-blind RED trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["dapa-hf","dapagliflozine","endotheel","flow-trial"],"journal":"Kidney international","doi":"10.1016/j.kint.2019.09.013","source_url":"https://doi.org/10.1016/j.kint.2019.09.013","authors":["Erik J M van Bommel","Marcel H A Muskiet","Michaël J B van Baar","Lennart Tonneijck","Mark M Smits","Anna L Emanuel","Andrea Bozovic","A H Jan Danser","Frank Geurts","Ewout J Hoorn","Daan J Touw","Emil L Larsen","Henrik E Poulsen","Mark H H Kramer","Max Nieuwdorp","Jaap A Joles","Daniël H van Raalte"],"significance":7,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This mechanistic study demonstrated that the renal hemodynamic effects of dapagliflozin are primarily mediated by post-glomerular vasodilation rather than afferent arteriolar constriction, providing new insight into how SGLT2 inhibitors protect the kidney.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat de renale hemodynamische effecten van dapagliflozine veroorzaakt worden door postglomerulaire vasodilatatie. Mechanistisch inzicht in SGLT2-nefroprotectie.","abstract_original":"Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve hard renal outcomes in type 2 diabetes. This is possibly explained by the fact that SGLT2i normalize the measured glomerular filtration rate (mGFR) by increasing renal vascular resistance, as was shown in young people with type 1 diabetes and glomerular hyperfiltration. Therefore, we compared the renal hemodynamic effects of dapagliflozin with gliclazide in type 2 diabetes. The mGFR and effective renal plasma flow were assessed using inulin and para-aminohippurate clearances in the fasted state, during clamped euglycemia (5 mmol/L) and during clamped hyperglycemia (15 mmol/L). Filtration fraction and renal vascular resistance were calculated. Additionally, factors known to modulate renal hemodynamics were measured. In 44 people with type 2 diabetes on metformin monotherapy (Hemoglobin A1c 7.4%, mGFR 113 mL/min), dapagliflozin versus gliclazide reduced mGFR by 5, 10, and 12 mL/min in the consecutive phases while both agents similarly improved Hemoglobin A1c (-0.48% vs -0.65%). Dapagliflozin also reduced filtration fraction without increasing renal vascular resistance, and increased urinary adenosine and prostaglandin concentrations. Gliclazide did not consistently alter renal hemodynamic parameters. Thus, beyond glucose control, SGLT2i reduce mGFR and filtration fraction in type 2 diabetes. The fact that renal vascular resistance was not increased by dapagliflozin suggests that this is due to post-glomerular vasodilation rather than pre-glomerular vasoconstriction."}