Evidence-based Colombian consensus and expert opinion regarding the use of sodium-glucose cotransporter type 2 (iSGLT-2) inhibitors in the cardiorenal continuum in patients with chronic kidney disease

Background: The treatment of chronic kidney disease (CKD) aims to decrease the risk of disease progression, emergence of complications, and risk of death, especially considering the cardiorenal continuum. Different clinical trials conducted with diabetic and non-diabetic individuals, as well as other risk groups such as heart failure and CKD, and antidiabetic drugs known as sodium-glucose cotransporter type 2 (iSGLT-2) inhibitors have shown beneficial effects on renal and cardiovascular outcomes. Purpose: The objective of this consensus was to establish recommendations for management with iSGLT-2 by patients with CKD. Methodology: The consensus was developed in the following stages: formation of the development group; definition of the research questions; search, screening, evaluation, and selection of evidence; synthesis and evaluation of the evidence; discussion in formal panels; generation of recommendations and expert judgment; and drafting, elaboration, and revision of the consensus document. Results: The 22 clinical experts formulated 15 recommendations for the 12 research questions. The certainty of the evidence ranged from moderate to high based primarily on clinical practice guidelines, systematic literature reviews, clinical trials, and expert consensus. Most of the recommendations were weak. Conclusions: The recommendations formulated serve as guidelines for implementing iSGLT-2 treatment in Colombian patients with CKD and some of its complications and/or comorbidities. As new scientific evidence emerges, these recommendations should be cautiously reconsidered and revised.