UK Kidney Association Clinical Practice Guideline: Sodium-Glucose Co-transporter-2 (SGLT-2) Inhibition in Adults with Kidney Disease
Working Group co-chairs: Assoc. Prof William G. Herrington & Dr Andrew H. Frankel
- Final Version: 13 April 2023
- Review Date: 13 April 2027
The Guideline
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Since the publication of the first UKKA clinical practice guideline for the use of SGLT-2 inhibition in adults with kidney disease in October 2021, two large and highly relevant clinical trials have been published (DELIVER and EMPA-KIDNEY). In light of this new evidence, the 2021 guidelines have been reviewed and updated by the original working group members. The structure of the 2021 guideline which provided recommendations for use for people with diabetes (section 2) and without diabetes (section 3) separately has been retained.
- Recommendations for Use in people with Type 2 DM
- Recommendations for Use in people without DM
- Recommendations for Implementation – People with or without DM (excluding Type 1 DM)
Our ‘Recommendations for Use’ of SGLT-2 inhibition in chronic kidney disease (CKD) in people with diabetes mellitus (DM) are, wherever possible, evidence-based. They were developed after review of the relevant published randomized trials.
The large-scale placebo-controlled trials of SGLT-2 inhibitors have not been powered to assess effects on kidney disease progression in people without diabetes mellitus (DM) considered in isolation.9
There are currently four sodium-glucose co-transporter-2 (SGLT-2) inhibitors that have a licence for use within the UK: canagliflozin, dapagliflozin, empagliflozin and ertugliflozin.
Licences for medications in the UK are issued by the Medicines and Healthcare products Regulatory Agency (MHRA).
All medications have both beneficial and adverse effects. This section is designed to highlight the key adverse effects identified to result from use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors and guide how these medicines can be initiated and continued safely, minimising the risk of harm.9
This section is designed for patients and carers and for healthcare workers who wish to obtain a lay summary of this guideline. The section contains a one-page executive lay summary followed by a full lay guideline summary.
This section covers
- Type 1 diabetes mellitus (DM)
- Kidney transplant recipients and
- Acute decompensated heart failure
| Abbreviation | Definition |
| ABCD-RA | Association of British Clinical Diabetologists-Renal Association |
| ACEi | Angiotensin-Converting Enzyme Inhibitor |
| ADA | American Diabetes Association |
| AF | Atrial Fibrillation |
| AKI | Acute Kidney Injury |
The systematic search was designed using a multi-stage process to maximise sensitivity to small trials (irrespective of recruitment of individuals with kidney disease) and to permit the inclusion of additional of interest in future iterations of the clinical guideline.
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