Elias John Elenjickal, Christoforos K Travlos, Judy Luu, Serge Lemay, Rita S Suri, Thomas A Mavrakanas
{"title":"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。","authors":"Elias John Elenjickal, Christoforos K Travlos, Judy Luu, Serge Lemay, Rita S Suri, Thomas A Mavrakanas","doi":"10.2215/CJN.0000000693","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>SGLT-2 inhibitors retain their kidney and cardiovascular protective effect in patients with advanced CKD, with no added safety concerns.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5000,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of SGLT-2 Inhibitors in Patients With and Without Advanced CKD: A Systematic Review and Meta-Analysis.\",\"authors\":\"Elias John Elenjickal, Christoforos K Travlos, Judy Luu, Serge Lemay, Rita S Suri, Thomas A Mavrakanas\",\"doi\":\"10.2215/CJN.0000000693\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>SGLT-2 inhibitors retain their kidney and cardiovascular protective effect in patients with advanced CKD, with no added safety concerns.</p>\",\"PeriodicalId\":50681,\"journal\":{\"name\":\"Clinical Journal of the American Society of Nephrology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.5000,\"publicationDate\":\"2025-03-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Journal of the American Society of Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2215/CJN.0000000693\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Journal of the American Society of Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2215/CJN.0000000693","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Efficacy and Safety of SGLT-2 Inhibitors in Patients With and Without Advanced CKD: A Systematic Review and Meta-Analysis.
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.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
