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Gérard AO, Laurain A, Sicard A, Merino D, Pathak A, Drici MD, Favre G, Esnault VLM. New Strategies for Volume Control in Patients with Diabetes Mellitus, a Narrative Review. Pharmaceutics 2022; 14:pharmaceutics14081569. [PMID: 36015195 PMCID: PMC9413771 DOI: 10.3390/pharmaceutics14081569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022] Open
Abstract
Sodium is reabsorbed all along the renal tubules. The positive impacts of sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin receptor neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonists (MRA) on hard renal and/or cardiac endpoints calls for the role of diuretics in nephroprotection and cardioprotection in patients with diabetes mellitus to be reviewed. Here, we review: (a) the mechanisms of action of the available natriuretics; (b) the physiological adaptations to chronic loop diuretic usage that lead to increased sodium reabsorption in the proximal and distal convoluted tubules; (c) the physiology of sodium retention in patients with diabetes mellitus; and (d) the mechanisms of aldosterone breakthrough. We show the rationale for combined diuretics to target not only the loop of Henle, but also the proximal and distal convoluted tubules. Indeed, higher residual proteinuria in patients treated with renin-angiotensin-aldosterone system (RAAS) blockers portends poorer renal and cardiovascular outcomes. Diuretics are known to optimize the reduction of proteinuria, in addition to RAAS blockers, but may favor aldosterone breakthrough in the absence of MRA. The aim of our study is to support a combined diuretics strategy to improve the management of patients with diabetes mellitus and chronic kidney disease or heart failure.
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Affiliation(s)
- Alexandre O. Gérard
- Nephrology-Dialysis-Transplantation Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (A.O.G.); (A.L.); (A.S.); (G.F.)
- Pharmacology Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (D.M.); (M.-D.D.)
| | - Audrey Laurain
- Nephrology-Dialysis-Transplantation Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (A.O.G.); (A.L.); (A.S.); (G.F.)
| | - Antoine Sicard
- Nephrology-Dialysis-Transplantation Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (A.O.G.); (A.L.); (A.S.); (G.F.)
| | - Diane Merino
- Pharmacology Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (D.M.); (M.-D.D.)
| | - Atul Pathak
- Centre Hospitalier Princesse Grace, 98000 Monaco, Monaco;
| | - Milou-Daniel Drici
- Pharmacology Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (D.M.); (M.-D.D.)
| | - Guillaume Favre
- Nephrology-Dialysis-Transplantation Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (A.O.G.); (A.L.); (A.S.); (G.F.)
| | - Vincent L. M. Esnault
- Nephrology-Dialysis-Transplantation Department, Pasteur Hospital, Université Côte d’Azur, 06001 Nice, France; (A.O.G.); (A.L.); (A.S.); (G.F.)
- Correspondence:
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Crea F. Sodium-glucose co-transporter inhibitors, iron therapy, and checkpoint inhibitors: new clinical and translational pieces of the heart failure puzzle. Eur Heart J 2021; 42:4871-4875. [PMID: 34932800 DOI: 10.1093/eurheartj/ehab857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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