Beneficial effect of sodium-glucose cotransporter 2 inhibitors on kidney function can be just a mirage

Figure 1 The increase in the glomerular filtration rate induced by sodium-glucose cotransporter-2 inhibitors does not correspond to an improvement in kidney function. Sodium-glucose cotransporter-2 (SGLT2) inhibitors induce: (1) Adaptive glomerular hyperfiltration in response to glucosuria and subsequent osmotic diuresis; and (2) Loss of skeletal muscle mass that reduces serum creatinine concentration. Lower serum creatinine level leads to an overestimation of kidney function when estimated glomerular filtration rate (GFR) is calculated with serum creatinine-based equations. The increase in serum creatinine-based estimated GFR associated with SGLT2 inhibitors may be attributable to either one or both of these confounding processes and may not reflect a beneficial effect on kidney function. SGLT2: Sodium-glucose cotransporter-2; GFR: Glomerular filtration rate.