1.8.3.0 Di­rect Renal Ef­fects of Glu­cose-‍Low­er­ing Med­i­ca­tions

Some glu­cose-low­er­ing med­i­ca­tions also have ef­fects on the kid­ney that are di­rect, i.e., not me­di­at­ed through glycemia. For ex­am­ple, SGLT2 in­hibitors re­duce renal tubu­lar glu­cose re­ab­sorp­tion, weight, sys­temic blood pres­sure, intraglomeru­lar pres­sure, and al­bu­minuria and slow GFR loss through mech­a­nisms that ap­pear in­de­pen­dent of glycemia (18,40–43). Glucagon-‍like pep­tide 1 re­cep­tor ag­o­nists (GLP-1 RA) also have di­rect ef­fects on the kid­ney and have been re­port­ed to im­prove renal out­comes com­pared with place­bo (44-47). Renal ef­fects should be con­sid­ered when se­lect­ing antihy­per­glycemia agents (see Sec­tion 9 “Phar­ma­co­log­ic Ap­proach­es to Glyce­mic Treat­ment”).