Sodium glucose cotransport-2 inhibition and intrarenal RAS activity in people with type 1 diabetes

To the Editor: Recently, Musetti et al. commented on the potential renal effects of sodium glucose co-transport-2 inhibition (SGLT2-i), as reviewed by Gilbert.1, 2 They specifically elaborated on Gilbert’s hypothesis that SGLT2-i may be reminiscent of renin–angiotensin system (RAS) blockade, indicating that such an intervention may also downregulate the RAS, thereby increasing the risk of hyperkalemia and hemodynamic kidney injury.