Impact of baseline kidney function on the effects of sodium‐glucose co‐transporter‐2 inhibitors on kidney and heart failure outcomes: A systematic review and meta‐analysis of randomized controlled trials

Aim To determine whether the magnitude of the cardiorenal benefits of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2is) varies with baseline kidney function. Methods We searched randomized, placebo‐controlled trials testing the effects of SGLT2is on renal and cardiovascular outcomes. Efficacy out...

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Bibliographic Details
Published in:Diabetes, obesity & metabolism obesity & metabolism, 2023-05, Vol.25 (5), p.1341-1350
Main Authors: Maddaloni, Ernesto, Cavallari, Ilaria, La Porta, Ylenia, Appetecchia, Alessandro, D'Onofrio, Luca, Grigioni, Francesco, Buzzetti, Raffaella, Holman, Rury R.
Format: Article
Language:English
Subjects:
cardiovascular outcomes
Congestive heart failure
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Disease Progression
Epidermal growth factor receptors
Glomerular Filtration Rate
Glucose transporter
Heart diseases
Heart failure
Heart Failure - epidemiology
Heart Failure - prevention & control
Humans
Kidney
kidney disease
Kidney Diseases
kidney failure
Kidneys
Meta-analysis
Randomized Controlled Trials as Topic
Renal failure
Risk assessment
SGLT2is
Sodium-Glucose Transporter 2 Inhibitors - pharmacology
Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
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Summary:Aim To determine whether the magnitude of the cardiorenal benefits of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2is) varies with baseline kidney function. Methods We searched randomized, placebo‐controlled trials testing the effects of SGLT2is on renal and cardiovascular outcomes. Efficacy outcomes, stratified by baseline estimated glomerular filtration rate (eGFR) categories, included renal disease progression, a composite heart failure (HF) outcome and mortality. Results Thirteen trials testing SGLT2is in 90 402 participants with available eGFR data were included. The risk of bias was judged as low for all trials. SGLT2is reduced the relative risks of renal disease progression by 27% to 57% and of HF outcomes by 13% to 32% across different eGFR categories, with an overall low heterogeneity. Meta‐regression analyses showed a significant direct relationship between baseline eGFR and the magnitude of SGLT2is’ renal protection (P = .003). The greatest risk reduction was in participants with an eGFR of 90 ml/min/1.73m2 or higher (HR 0.43, 95% CI: 0.32‐0.58) and the smallest was in those with an eGFR of less than 30 ml/min/1.73m2 (HR 0.73, 95% CI: 0.62‐0.86, P 
ISSN:1462-8902
1463-1326
DOI:10.1111/dom.14986