SGLT2 Inhibitors in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder, with tolvaptan remaining the primary disease-modifying therapy. SGLT2 inhibitors have demonstrated robust renoprotection across the chronic kidney disease (CKD) spectrum, yet patients with ADPKD have been systematically excluded from pivotal trials due to concerns over vasopressin-mediated cystogenesis. This systematic review and meta-analysis aimed to pool available evidence on SGLT2 inhibitor use in patients with ADPKD. This systematic review and meta-analysis were registered with PROSPERO (CRD420261324155) and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines. Five databases were searched through February 2026 for studies including ADPKD patients receiving any SGLT2 inhibitor. Quality was assessed using the Risk of Bias 2 (RoB2), Newcastle-Ottawa Scale, and Joanna Briggs Institute (JBI) tools, depending on the study design. Eight studies encompassing 3,180 patients were included, comprising one randomized controlled trial (RCT), one target trial emulation study, and six retrospective observational studies. In comparative analyses, SGLT2 inhibitor use was associated with a statistically significant attenuation of estimated glomerular filtration rate (eGFR) decline (pooled mean difference {MD}: 1.344 mL/min/1.73 m²/year; 95% CI: 0.836-1.852). A significant hemoglobin increase was observed in both comparative…
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: 3,180 participants or records.
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