Sodium-Glucose Cotransporter-2 Inhibitors and Acute Kidney Injury Risk: A Systematic Review and Meta-Analysis of Randomized Trials
Abstract
Rationale & objective: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) provide cardiovascular and renal benefits in individuals with or without type 2 diabetes. This systematic review and meta-analysis investigated the risks of acute kidney injury and other adverse events (AEs) associated with SGLT2is across diverse populations.
Study design: Systematic review and meta-analysis of randomized controlled trials (RCTs).
Setting & study populations: Thirteen RCTs comprising 84,581 participants were included. The studies encompassed diverse populations, varying in diabetes status, presence of chronic kidney disease, and SGLT2i dosages.
Selection criteria for studies: We included RCTs published through December 31, 2023, that evaluated the safety and efficacy of SGLT2is and reported renal and nonrenal adverse outcomes.
Data extraction: Two reviewers independently extracted data and resolved discrepancies by consensus, focusing on renal and nonrenal AEs and subgroup analyses.
Analytical approach: Random-effects meta-analysis was performed to estimate pooled relative risks or odds ratios with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic.
Results: SGLT2is were associated with a 20% reduction in the risk of acute kidney injury (relative risk, 0.80; 95% CI, 0.74-0.87), with low between-study heterogeneity, supporting a consistent renoprotective effect. Among patients with chronic kidney disease, the risk of renal composite outcomes was also…
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: 84,581 participants or records.
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