Wang Xianghong, He Meihong, Jin Donghua, Sun Chuanchuan, Lu Hongyun
Department of Endocrinology and Metabolism, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China.
The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.
Diabetol Metab Syndr. 2024 Aug 27;16(1):207. doi: 10.1186/s13098-024-01446-1.
Sodium glucose cotransporter-2 (SGLT-2) inhibitors are known to reduce hospitalization and cardiovascular mortality in various heart failure (HF) populations, potentially through enhanced excretion of water and sodium. However, there are concerns regarding the risk of acute kidney injury (AKI) associated with their use. This meta-analysis aimed to unravel the effects of SGLT-2 inhibitors on risk of AKI in a variety of patients with HF.
This study conducted a comprehensive literature search using PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov for studies published up to January 1, 2024. Data were analyzed using both random-effects or fixed-effects models to estimate the overall relative risk (RR) with a 95% confidence interval (CI).
Our analysis included 25,172 patients with HF from 16 randomized controlled trials. Treatment with SGLT-2 inhibitors led to a 28% reduction in the risk of AKI progression compared to placebo (RR 0.72, 95% CI 0.61-0.85, p<0.0001), without an increased risk of hypotension (RR 1.21, 95% CI 0.87-1.70, p = 0.26) and hypovolemia (RR 2.26, 95% CI: 0.70-7.33, p = 0.17). Notably, SGLT-2 inhibitors significantly decreased AKI in specific subgroups, including patients with HF with reduced ejection fraction (RR 0.59, 95% CI 0.43-0.80, p = 0.0007), those treated with empagliflozin (RR 0.70, 95% CI 0.57-0.88, p = 0.002) or dapagliflozin (RR 0.74, 95% CI 0.57-0.98, p = 0.04), in studies with a follow-up of at least 1 year (RR 0.67, 95% CI 0.55-0.82, p = 0.0001), and in patients aged 65 years or older (RR 0.72, 95% CI 0.61-0.85, p < 0.0001).
Use of SGLT-2 inhibitors did not increase the incidence of AKI regardless of the ejection fraction environment (chronic and acute), type of SGLT-2 inhibitors, or patient age.
已知钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂可降低各类心力衰竭（HF）人群的住院率和心血管死亡率，这可能是通过增强水和钠的排泄来实现的。然而，人们担心其使用会带来急性肾损伤（AKI）风险。本荟萃分析旨在阐明SGLT-2抑制剂对各类HF患者AKI风险的影响。
本研究使用PubMed、EMBASE、Cochrane图书馆和clinicaltrials.gov对截至2024年1月1日发表的研究进行了全面的文献检索。使用随机效应或固定效应模型分析数据，以估计总体相对风险（RR）及95%置信区间（CI）。
我们的分析纳入了来自16项随机对照试验的25172例HF患者。与安慰剂相比，使用SGLT-2抑制剂使AKI进展风险降低了28%（RR 0.72，95%CI 0.61-0.85，p<0.0001），低血压风险（RR 1.21，95%CI 0.87-1.70，p = 0.26）和血容量不足风险（RR 2.26，95%CI：0.70-7.33，p = 0.17）均未增加。值得注意的是，SGLT-2抑制剂在特定亚组中显著降低了AKI，包括射血分数降低的HF患者（RR 0.59，95%CI 0.43-0.80，p = 0.0007）、接受恩格列净治疗的患者（RR 0.70，95%CI 0.57-0.88，p = 0.002）或达格列净治疗的患者（RR 0.74，95%CI 0.57-0.98，p = 0.04）、随访至少1年的研究中的患者（RR 0.67，95%CI 0.55-0.82，p = 0.0001）以及65岁及以上的患者（RR 0.72，95%CI 0.61-0.85，p < 0.0001）。
无论射血分数情况（慢性和急性）、SGLT-2抑制剂类型或患者年龄如何，使用SGLT-2抑制剂均不会增加AKI的发生率。
