{"id":"90dab6e81d67","type":"article","url":"https://hartvaat.nl/2026/06/30/sglt2-remmers-breiden-indicatie-uit-naar-niet-diabetische-nier-en-hartfalenziekt/","title":"SGLT2-remmers breiden indicatie uit naar niet-diabetische nier- en hartfalenziekte","title_en":"[Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i): A Therapeutic Revolution Beyond Diabetes. New Indications in Non-Diabetic Chronic Kidney Disease and Heart Failure].","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","doi":"10.69097/43-03-2026-09","source_url":"https://doi.org/10.69097/43-03-2026-09","authors":["Fabio Pio Gentile"],"significance":5,"published":"2026-08-01","source_date":"2026-06-30","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This narrative review synthesizes evidence on sodium-glucose cotransporter 2 inhibitors (SGLT2i) for non-diabetic chronic kidney disease and heart failure with reduced or preserved ejection fraction. Large trials demonstrate that SGLT2i improve renal and cardiac outcomes independent of diabetes status, primarily through restoration of tubuloglomerular feedback and favorable shifts in myocardial metabolism. The review provides practical guidance for clinicians on dose adjustment, monitoring the expected initial eGFR decline, and preventing euglycemic ketoacidosis.","created":"2026-07-24T01:24:41Z","updated":"2026-08-10T10:37:32Z","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":"Deze review vat de klinische bewijslast en werkingsmechanismen samen van SGLT2-remmers bij niet-diabetische chronische nierziekte (CKD) en hartfalen (HFrEF en HFpEF). Uit grote trials (DAPA-CKD, EMPA-KIDNEY, DAPA-HF, EMPEROR-Preserved) blijkt dat deze middelen renale en cardiale uitkomsten verbeteren onafhankelijk van diabetesstatus, voornamelijk via restauratie van tubulo-glomerulaire feedback en verbetering van myocardiaal metabolisme. Voor de klinische praktijk biedt de review praktische handvatten voor dosering en het managen van bijwerkingen zoals de initiële eGFR-daling en het risico op euglykemische ketoacidose.","abstract_original":"Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i), initially developed as hypoglycemic agents, have revolutionized the management of cardiorenal diseases due to potent organ-protective effects. Evidence from large clinical trials (DAPA-CKD, EMPA-KIDNEY, DAPA-HF, EMPEROR-Preserved) has established that their renal and cardiac benefits manifest independently of the presence of Type 2 Diabetes Mellitus (T2DM). Renally, nephroprotection mainly stems from the restoration of tubulo-glomerular feedback, which reduces hyperfiltration and intraglomerular pressure, thereby mitigating structural damage in non-diabetic Chronic Kidney Disease (CKD). Cardiologically, SGLT2i improve myocardial metabolism and reduce congestion, demonstrating efficacy in both Heart Failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). This review synthesizes the pleiotropic mechanisms of action and the clinical evidence that extends the use of SGLT2i across the entire spectrum of CKD (eGFR ≥ 20 mL/min/1.73 m2) and Heart Failure offering practical considerations for clinicians regarding dosing and the management of adverse events, such as the initial eGFR dip and the prevention of euglycemic ketoacidosis."}