Faculty of Medicine, Universidad de Piura, Lima, Lima, Peru.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America.
PLoS One. 2023 Nov 29;18(11):e0295059. doi: 10.1371/journal.pone.0295059. eCollection 2023.
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have shown a favorable effect on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM). However, their efficacy in patients with chronic kidney disease (CKD) with or without T2DM has not yet been analyzed.
To assess the cardiovascular and renal effects of SGLT-2 inhibitors in patients with CKD with and without T2DM, including all CKD patients in the current literature.
We searched MEDLINE, EMBASE, CENTRAL and Scopus for randomized controlled trials of SGLT-2 inhibitors that evaluated cardiovascular and kidney outcomes in patients with CKD, or trials in which these patients were a subgroup. We defined 2 primary outcomes: a composite of cardiovascular death or hospitalization for heart failure, and a composite renal outcome. For each outcome, we obtained overall hazard ratios with 95% confidence intervals by using a random effects model.
We included 14 randomized controlled trials. SGLT-2 inhibitors decreased the hazard for the primary cardiovascular outcome (HR 0.76; [95% CI 0.72-0.79]) and the primary renal outcome (HR 0.69; [95% CI 0.61-0.79]) in patients with CKD with or without T2DM. We did not find significant differences in the subgroup analyses according to diabetes status, baseline eGFR values or the type of SGLT-2 inhibitor used.
In patients with CKD, treatment with SGLT-2 inhibitors in addition to standard therapy conferred protection against cardiovascular and renal outcomes. Further research on patients with non-diabetic CKD should be done to confirm the utility of these medications in this population. (PROSPERO ID: CRD42021275012).
钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂已显示出对 2 型糖尿病（T2DM）患者心血管和肾脏结局的有利影响。然而，它们在伴有或不伴有 T2DM 的慢性肾脏病（CKD）患者中的疗效尚未得到分析。
评估 SGLT-2 抑制剂在伴有和不伴有 T2DM 的 CKD 患者中的心血管和肾脏作用，包括当前文献中所有 CKD 患者。
我们在 MEDLINE、EMBASE、CENTRAL 和 Scopus 中搜索了 SGLT-2 抑制剂的随机对照试验，这些试验评估了 CKD 患者的心血管和肾脏结局，或这些患者为亚组的试验。我们定义了 2 个主要结局：心血管死亡或心力衰竭住院的复合结局，以及肾脏复合结局。对于每个结局，我们使用随机效应模型获得了总体危险比及其 95%置信区间。
我们纳入了 14 项随机对照试验。SGLT-2 抑制剂降低了伴有或不伴有 T2DM 的 CKD 患者的主要心血管结局（HR 0.76；[95%CI 0.72-0.79]）和主要肾脏结局（HR 0.69；[95%CI 0.61-0.79]）的风险。我们未发现根据糖尿病状态、基线 eGFR 值或 SGLT-2 抑制剂类型进行的亚组分析中的差异。
在 CKD 患者中，除标准治疗外，使用 SGLT-2 抑制剂治疗可预防心血管和肾脏结局。应进一步研究非糖尿病性 CKD 患者，以确认这些药物在该人群中的效用。（PROSPERO ID：CRD42021275012）。
