According to KDIGO guidelines, should a sodium‑glucose co‑transporter‑2 (SGLT2) inhibitor be started in any adult with type 2 diabetes whose estimated glomerular filtration rate (eGFR) is ≥20 mL/min/1.73 m², regardless of albuminuria?

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Last updated: September 27, 2026 • View editorial policy

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Sí, según KDIGO, los inhibidores SGLT2 deben iniciarse en adultos con diabetes tipo 2 y TFGe ≥20 mL/min/1.73 m², independientemente del nivel de albuminuria.

Las guías KDIGO 2022 y 2024 recomiendan con nivel de evidencia 1A iniciar un inhibidor SGLT2 en todos los pacientes con diabetes tipo 2, enfermedad renal crónica y TFGe ≥20 mL/min/1.73 m², sin requerir la presencia de albuminuria 1, 2.

Recomendación Principal

La recomendación KDIGO 2022 establece explícitamente: "Recomendamos tratar a pacientes con diabetes tipo 2, ERC y TFGe ≥20 ml/min/1.73 m² con un inhibidor SGLT2 (1A)" 1. Esta recomendación no condiciona el tratamiento a la presencia de albuminuria.

Matices Importantes de las Guías KDIGO 2024

Las guías KDIGO 2024 refinan esta recomendación estratificando por nivel de albuminuria 2:

  • TFGe ≥20 con ACR ≥200 mg/g o insuficiencia cardíaca: Recomendación 1A (la más fuerte)
  • TFGe 20-45 con ACR <200 mg/g: Recomendación 2B (sugerencia con evidencia moderada)

Sin embargo, ambas categorías reciben recomendación de tratamiento, solo varía la fuerza de la evidencia. La ausencia de albuminuria no contraindica el uso de inhibidores SGLT2.

Justificación Clínica

Los inhibidores SGLT2 proporcionan protección renal y cardiovascular que va más allá del control glucémico 1. Las guías enfatizan que estos medicamentos pueden agregarse al régimen actual de tratamiento hipoglucemiante, ya que su beneficio es independiente del efecto sobre la glucosa 1.

Consideraciones Prácticas Clave

Antes de iniciar:

  • Evaluar riesgo de hipovolemia; considerar reducir diuréticos tiazídicos o de asa antes del inicio 1
  • Educar sobre síntomas de depleción de volumen e hipotensión 1

Durante el tratamiento:

  • Una disminución reversible de la TFGe al iniciar es esperada y generalmente no es indicación para suspender 1, 2
  • Suspender temporalmente durante ayuno prolongado, cirugía o enfermedad crítica (riesgo de cetosis) 1, 2

Continuación del tratamiento:

  • Una vez iniciado, es razonable continuar el inhibidor SGLT2 incluso si la TFGe cae por debajo de 20 mL/min/1.73 m², a menos que no se tolere o se inicie terapia de reemplazo renal 1, 2, 3

Advertencia Importante

La recomendación no aplica a receptores de trasplante renal, quienes no han sido adecuadamente estudiados y pueden tener mayor riesgo de infecciones debido a la inmunosupresión 1.

References

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