Placebo-Referenced Class-Level Treatment Effects on Chronic Kidney Disease Progression in Patients With Diabetes: A Network Meta-Analysis
Abstract
Background and aim: Multiple pharmacologic therapies reduce chronic kidney disease (CKD) progression in patients with diabetes; however, the absence of head-to-head trials and heterogeneity across studies limits the interpretation of indirect comparisons. We evaluated class-level treatment effects within a predominantly placebo-centred evidence network.
Methods: We conducted a systematic review and class-level frequentist random-effects network meta-analysis of randomised controlled trials evaluating major pharmacologic therapy classes for CKD progression in patients with diabetes. The primary outcome was CKD progression, defined according to the principal composite kidney endpoint reported in each trial. Exploratory analyses evaluated albuminuria reduction and trial-level surrogate associations between albuminuria and clinical kidney outcomes.
Results: Nine trials involving 37,749 participants were included. The evidence network was star-shaped with placebo as the central comparator. All therapeutic classes were associated with reduced CKD progression compared with placebo. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) demonstrated the most precise estimate (HR 0.66, 95% CI 0.60-0.74) and were supported by high-confidence evidence. Confidence in placebo-referenced estimates for other therapeutic classes ranged from moderate to low because of indirectness, limited trial numbers and differences in study design and patient populations. Findings were generally consistent…
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: 37,749 participants or records.
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