Institute of Cardiovascular and Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK.
West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, G81 4DY Glasgow, UK.
Rev Cardiovasc Med. 2021 Dec 22;22(4):1479-1490. doi: 10.31083/j.rcm2204152.
Chronic kidney disease (CKD) and cardiovascular disease share common risk factors such as hypertension, diabetes mellitus and dyslipidemia. Patients with CKD carry a high burden of cardiovascular disease and may be excluded from clinical trials on the basis of safety. There are an increasing number of clinical trials which predefine sub-group analysis for CKD. This systematic review with fixed-effect meta-analysis investigates glucose lowering therapy and cardiovascular outcomes in relation to CKD. We included randomized controlled trials (RCT) of glucose lowering treatments performed in adults (aged ≥18 years), humans, with no restriction on date, and English-language restriction in patients with pre-existing CKD regardless of diabetes status. Embase & Ovid Medline databases were searched up to April 2021. Risk of bias was assessed according to Revised Cochrane risk-of-bias tool. We included 7 trials involving a total of 48,801 participants. There were 4 sodium-glucose cotransporter-2 inhibitors (SGLT2i), 2 glucagon-like peptide-1 receptor (GLP-1R) agonists and 1 Dipeptidyl-peptidase 4 (DPP4) inhibitor identified. SGLT2i (relative risk (RR) = 0.90, 95% confidence interval (CI) [0.79-1.02]) and GLP-1R agonists (RR = 0.83, 95% CI [0.72-0.96]) were associated with a reduction in cardiovascular death. SGLT2i (RR = 0.69, 95% CI [0.63-0.75]) are also associated with a reduction in hospitalization for heart failure. In summary, this meta-analysis of large, RCTs of glucose lowering therapies has demonstrated that treatment with SGLT2i or GLP-1R agonists may improve 3 point-MACE and cardiovascular outcomes in patients with chronic renal failure compared with placebo. This systematic review was registered with the PROSPERO network (registration number: CRD42021268563) and follows the PRISMA guidelines on systematic reviews and metanalysis.
慢性肾脏病（CKD）和心血管疾病有共同的危险因素，如高血压、糖尿病和血脂异常。CKD 患者心血管疾病负担沉重，可能因安全性原因而被排除在临床试验之外。越来越多的临床试验对 CKD 进行了亚组分析。本系统评价采用固定效应荟萃分析研究了降糖治疗与 CKD 相关的心血管结局。我们纳入了在成年人（年龄≥18 岁）中进行的降糖治疗的随机对照试验（RCT），不限制研究日期，且在无糖尿病的情况下，对无论糖尿病状态如何的已有 CKD 的患者，英语语言限制。我们在 Embase 和 Ovid Medline 数据库中检索了截至 2021 年 4 月的文献。根据修订后的 Cochrane 偏倚风险工具评估了偏倚风险。我们纳入了 7 项共涉及 48801 名参与者的试验。其中有 4 种钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i）、2 种胰高血糖素样肽 1 受体（GLP-1R）激动剂和 1 种二肽基肽酶 4（DPP4）抑制剂。SGLT2i（相对风险（RR）=0.90，95%置信区间（CI）[0.79-1.02]）和 GLP-1R 激动剂（RR=0.83，95%CI [0.72-0.96]）与心血管死亡风险降低相关。SGLT2i（RR=0.69，95%CI [0.63-0.75]）也与心力衰竭住院治疗减少相关。总之，这项对大型降糖治疗 RCT 的荟萃分析表明，与安慰剂相比，SGLT2i 或 GLP-1R 激动剂治疗可能改善慢性肾衰竭患者的 3 点-MACE 和心血管结局。本系统评价已在 PROSPERO 网络（注册号：CRD42021268563）上注册，并遵循 PRISMA 系统评价和荟萃分析指南。
