钠-葡萄糖共转运蛋白 2 抑制剂在慢性肾脏病中的肾脏保护和安全性。

Renal Protection and Safety of Sodium-glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease.

机构信息

Department of Nephrology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.

出版信息

Curr Pharm Des. 2023;29(21):1659-1670. doi: 10.2174/1381612829666230804103643.

DOI:10.2174/1381612829666230804103643

PMID:37537933

Abstract

INTRODUCTION

Chronic kidney disease (CKD) has a clinical characteristic of progressive loss of kidney function and becomes a serious health and social concern. SGLT2i (sodium-glucose cotransporter 2 inhibitors), a class of anti-diabetic medications, are shown to reduce cardiovascular and renal events. This systematic review and meta-analysis aimed to assess whether SGLT2i could become a new treatment strategy for CKD for its renal protection and safety.

METHODS

Based on predetermined criteria, a bibliographical search was performed on May 31, 2022, by searching the following databases: ISI Web of Science, Embase, PubMed, and the Cochrane Library. Statistical analysis was conducted to assess renal protection and safety of SGLT2i by using Cochrane Review Manager Version 5.3.

RESULTS

Thirty randomised controlled trials fulfilled the inclusion criteria and were eligible for this meta-analysis. Our study found that the SGLT2i can sustainably reduce the urine albumin/creatinine ratio (UACR) at different time points and prevent the progression to macroalbuminuria. Before 24 weeks, SGLT2i can decrease the estimated glomerular filtration rate (eGFR) compared to the control group. Interestingly, after 24 weeks, SGLT2i can continuously maintain the increase in eGFR when compared with the control group. Furthermore, SGLT2i can reduce the event rates of incident or worsening nephropathy, a decline in estimated eGFR of ≥ 50%, doubling of serum creatinine level, acute renal failure and renal failure. Interestingly, the renoprotective effects of SGLT2i are independent of its glycemic effects. SGLT2i can reduce the morbidity rate of any related adverse events, any related severe adverse events and SGLT2i have not increased the event rates of urinary tract infection, bone fractures, amputation, and acute pancreatitis when compared with the control group.

CONCLUSION

SGLT2i can protect renal function and are safe drug for CKD. SGLT2i are promising therapeutic agents for CKD patients.

摘要

简介

慢性肾脏病（CKD）具有肾功能进行性丧失的临床特征，已成为严重的健康和社会问题。SGLT2i（钠-葡萄糖协同转运蛋白 2 抑制剂）是一类抗糖尿病药物，已被证明可减少心血管和肾脏事件。本系统评价和荟萃分析旨在评估 SGLT2i 是否可以因其肾脏保护和安全性而成为 CKD 的新治疗策略。

方法

根据预定标准，于 2022 年 5 月 31 日通过检索以下数据库进行文献检索：ISI Web of Science、Embase、PubMed 和 Cochrane 图书馆。使用 Cochrane 评论经理版本 5.3 进行统计分析，以评估 SGLT2i 的肾脏保护和安全性。

结果

符合纳入标准的 30 项随机对照试验有资格进行这项荟萃分析。我们的研究发现，SGLT2i 可以在不同时间点持续降低尿白蛋白/肌酐比值（UACR），并防止向大量白蛋白尿进展。在 24 周之前，SGLT2i 与对照组相比可以降低估计肾小球滤过率（eGFR）。有趣的是，在 24 周后，与对照组相比，SGLT2i 可以持续维持 eGFR 的增加。此外，SGLT2i 可以降低发生或恶化肾病、估计 eGFR 下降≥50%、血清肌酐水平翻倍、急性肾衰竭和肾衰竭的事件发生率。有趣的是，SGLT2i 的肾脏保护作用与其血糖作用无关。SGLT2i 可以降低任何相关不良事件、任何相关严重不良事件的发病率，与对照组相比，SGLT2i 并未增加尿路感染、骨折、截肢和急性胰腺炎的事件发生率。