Efficacy and Safety of SGLT-2 Inhibitors in Patients With and Without Advanced CKD: A Systematic Review and Meta-Analysis.

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-26 DOI:10.2215/CJN.0000000693

Elias John Elenjickal, Christoforos K Travlos, Judy Luu, Serge Lemay, Rita S Suri, Thomas A Mavrakanas

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引用次数: 0

Abstract

Background: The efficacy and safety of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in patients with advanced chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2, has not been adequately studied.

Methods: We conducted a systematic review and meta-analysis of phase 3 randomized controlled trials (RCTs) of SGLT-2 inhibitors in adults. We searched the MEDLINE and Embase databases from inception to April 2024. The primary outcomes were a composite kidney (worsening kidney function, kidney failure, kidney or cardiovascular death) and cardiovascular (cardiovascular death or hospitalization for heart failure) outcome. Secondary outcomes included other reported cardiovascular and kidney outcomes, eGFR slopes, mechanistic and safety outcomes. The relative risks (RR) were estimated using a random effects model. Interaction effects were estimated for treatment effect modification by baseline eGFR (<30 and ≥30 ml/min/1.73m2).

Results: A total of 10 RCTs were included (total of 4800 patients with eGFR <30 ml/min/1.73m2). Participants were randomized to receive either placebo or an SGLT-2 inhibitor. Use of SGLT-2 inhibitors was associated with a lower incidence of the primary composite kidney outcome in patients with eGFR <30 ml/min/1.73m2 [RR 0.79, 95% confidence interval (CI) 0.70-0.89] and ≥30 ml/min/1.73m2 (RR 0.71, 95% CI 0.64-0.79). The incidence of the primary cardiovascular outcome was numerically lower in the SGLT-2 inhibitor arm in patients with eGFR <30 ml/min/1.73m2 (RR 0.88, 95% CI 0.71-1.10). In patients with eGFR ≥30 ml/min/1.73m2, SGLT-2 inhibitor use was associated with a lower incidence of the composite cardiovascular outcome (RR 0.77, 95% CI 0.71-0.83). However, there was no interaction between advanced CKD status and the effect of SGLT-2 inhibitors on any of the primary or secondary outcomes. The incidence of adverse events was similar in both arms.

Conclusion: SGLT-2 inhibitors retain their kidney and cardiovascular protective effect in patients with advanced CKD, with no added safety concerns.

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SGLT-2抑制剂对晚期和非晚期慢性肾脏病患者的疗效和安全性：系统回顾和荟萃分析。

背景：钠-葡萄糖协同转运体-2（SGLT-2）抑制剂对晚期慢性肾病（CKD）患者的疗效和安全性，晚期慢性肾病是指估计肾小球滤过率（eGFR）方法：我们对成人 SGLT-2 抑制剂的 3 期随机对照试验 (RCT) 进行了系统回顾和荟萃分析。我们检索了从开始到 2024 年 4 月的 MEDLINE 和 Embase 数据库。主要结果是肾脏（肾功能恶化、肾衰竭、肾脏或心血管死亡）和心血管（心血管死亡或因心衰住院）的综合结果。次要结果包括其他报告的心血管和肾脏结果、eGFR斜率、机理和安全性结果。采用随机效应模型估算相对风险（RR）。对基线 eGFR 对治疗效果的影响进行了交互效应估算：共纳入了 10 项 RCT（共计 4800 例 eGFR 患者）：SGLT-2 抑制剂对晚期 CKD 患者的肾脏和心血管具有保护作用，且不增加安全性问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Journal of the American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

12.20

自引率

3.10%

发文量

514

审稿时长

3-6 weeks

期刊介绍： The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.