Impact of diabetes on the effects of SGLT2 inhibitors on kidney outcomes: An updated drug/dose-dependent meta-analysis
Abstract
Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors provide renal and cardiovascular benefits in diabetes, but their effects in non-diabetic populations remain unclear. This meta-analysis evaluates the renal outcomes of SGLT2 inhibitors vs. placebo, focusing on diabetes status, subgroup variations, and drug-specific effects.
Materials and methods: A systematic review of 31 randomized controlled trials (RCTs) (98,516 patients) was conducted. Studies including diabetic and non-diabetic patients were analyzed, with subgroup assessments based on diabetes status, drug type, dose, baseline estimated glomerular filtration rate (eGFR), chronic kidney disease (CKD) stage, and follow-up duration. Primary outcomes included kidney disease progression, while secondary outcomes encompassed renal adverse events, composite renal outcomes, acute kidney injury (AKI), diabetic ketoacidosis (DKA), and renal failure.
Results: SGLT2 inhibitors reduced progressive kidney disease risk in diabetic (OR = 0.64, 95% CI: 0.58 - 0.71) and non-diabetic patients (OR = 0.69, 95% CI: 0.57 - 0.83), with no effect modification by diabetes status (p = 0.49). Among diabetics, risk reductions were notable for canagliflozin 100 mg, dapagliflozin 10 mg, and empagliflozin 10-mg, particularly in patients with CKD stage 2 - 3 and baseline eGFR of 30 - 90 mL/min/1.73m2. Among non-diabetics, dapagliflozin and empagliflozin showed consistent benefit. No differences in renal adverse events were observed in…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 98,516 participants or records.
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