Sodium-glucose co-transporter 2 inhibitors for all-cause and cardiovascular death in people with different stages of CKD: A systematic review and meta-analysis.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-10-14 DOI:10.1111/eci.14335

Artemios G Karagiannidis, Marieta P Theodorakopoulou, Maria-Eleni Alexandrou, Fotini Iatridi, Eleni Karkamani, Vasileios Anastasiou, Ioannis Mykoniatis, Vasileios Kamperidis, Giovanni Strippoli, Pantelis Sarafidis

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引用次数: 0

Abstract

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2is) reduce cardiovascular risk in people with diabetes and established cardiovascular disease, but emerging studies in chronic kidney disease (CKD) have inconsistent results. In this systematic review, we evaluate the effects of SGLT2is on cardiovascular mortality in people with CKD as a whole and across subgroups stratified by baseline kidney function and among people at low, moderate, high and very high risk according to KDIGO- CKD classification system.

Methods: Literature search was conducted in PubMed/MEDLINE, Cochrane/CENTRAL, Scopus and Web of Science up to 30 November 2023. We included randomized controlled trials assessing the effect of SGLT2is on cardiovascular mortality in people with CKD. Secondary outcomes included all-cause mortality and major adverse cardiac events (MACE).

Results: Eleven studies (n = 83,203 participants) were included. In people with CKD, treatment with SGLT2is compared to placebo reduced the risk of cardiovascular death by 14% (hazard ratio [HR] .86; 95%CI .79-.94), all-cause death by 15% (HR .85; 95%CI .79-.91) and MACEs by 13% (HR .87; 95%CI .81-.93). A consistent treatment effect was observed across eGFR-subgroups (≥60 mL/min/1.73 m²: HR .82, 95%CI .65-1.02; <60 mL/min/1.73 m²: HR .86, 95%CI .77-.96, p-subgroup difference = .68) and KDIGO risk-categories (low, moderate, high and very high) (p-subgroup difference = .69) for cardiovascular death; reduction in the risk of all-cause death tended to be greater in the highest KDIGO risk categories. A consistent treatment effect on cardiovascular mortality was observed for different SGLT2is agents studied. Sensitivity analysis for cardiovascular mortality endpoint including studies in diabetic people yielded similar results (HR .86; 95%CI .77-.97).

Conclusions: Treatment with SGLT2is led to a significant reduction in the risk of cardiovascular and all-cause mortality in people with different CKD stages. These findings support the use of SGLT2is as an adjunct cardiovascular protective therapy in CKD.

Prospero registration number: PROSPERO registration number: CRD42022382863.

查看原文本刊更多论文

钠-葡萄糖共转运体 2 抑制剂对不同阶段慢性肾脏病患者全因和心血管死亡的影响：系统综述和荟萃分析。

背景：钠-葡萄糖共转运体-2抑制剂（SGLT2is）可降低糖尿病患者和已确诊心血管疾病患者的心血管风险，但针对慢性肾脏病（CKD）的新研究结果并不一致。在这篇系统综述中，我们评估了 SGLT2is 对整个 CKD 患者心血管死亡率的影响，以及根据 KDIGO- CKD 分类系统对基线肾功能分层的亚组和低危、中危、高危和极高危患者的影响：截至 2023 年 11 月 30 日，在 PubMed/MEDLINE、Cochrane/CENTRAL、Scopus 和 Web of Science 中进行了文献检索。我们纳入了评估 SGLT2is 对 CKD 患者心血管死亡率影响的随机对照试验。次要结果包括全因死亡率和主要心脏不良事件（MACE）：结果：共纳入 11 项研究（n = 83,203 名参与者）。在慢性肾脏病患者中，与安慰剂相比，SGLT2is治疗可使心血管死亡风险降低14%（危险比[HR].86；95%CI.79-.94），全因死亡风险降低15%（HR.85；95%CI.79-.91），MACE降低13%（HR.87；95%CI.81-.93）。不同 eGFR 亚组（≥60 mL/min/1.73 m2：HR .82，95%CI .65-1.02；2：HR .86，95%CI .77-.96，p-亚组差异 = .68）和 KDIGO 风险类别（低、中、高和极高）对心血管死亡的治疗效果一致（p-亚组差异 = .69）；在 KDIGO 风险最高的类别中，全因死亡风险的降低幅度往往更大。所研究的不同 SGLT2is 药物对心血管死亡的治疗效果一致。对包括糖尿病患者研究在内的心血管死亡率终点的敏感性分析得出了相似的结果（HR .86; 95%CI .77-.97）：结论：使用 SGLT2is 治疗可显著降低不同 CKD 阶段患者的心血管和全因死亡风险。这些研究结果支持使用 SGLT2is 作为 CKD 患者的心血管保护辅助疗法：PROSPERO 注册号CRD42022382863。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.