Diabetes: meta-analysis supports SGLT2 inhibitors to prevent renal failure

  • Neuen BL & al.
  • Lancet Diabetes Endocrinol
  • 5 Sep 2019

  • International Clinical Digest
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Takeaway

  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce the risk for dialysis, transplantation, or death due to kidney disease in a meta-analysis of patients with type 2 diabetes mellitus (T2DM).
  • Investigators observed renoprotective benefit against acute injury.

Why this matters

Study design

  • Systematic review and meta-analysis of 4 randomised controlled studies of SGLT2 inhibitors in 38,723 patients with T2DM (35.0% female; mean age, 63.0-63.9 years).
  • Agents included empagliflozin (EMPA-REG OUTCOME), canagliflozin (CANVAS Program, CREDENCE), and dapagliflozin (DECLARE-TIMI 58).
  • Funding: None.   

Key results

  • 252 patients (0.65%) met the primary endpoint of dialysis, transplantation, or death; 335 developed end-stage renal disease (ESRD, 0.87%); and 943 had acute kidney injury (AKI, 2.44%).
  • SGLT2 inhibitors yielded a 33% reduced risk for dialysis, transplantation, or death vs placebo (relative risk [RR]=0.67; P=.0019; I2=0.0%).
  • In subanalysis, SGLT2 inhibitors decreased risks for:
    • ESRD by 35% (RR=0.65; P<.0001 i>2=0.0%).
    • AKI by 25% (RR=0.75; P<.0001 i>2=0.0%).
  • Benefit was observed across all estimated glomerular filtration rate (in mL/minute per 1.73 m2) subgroups:
    • 60 to 2=0.0%);
    • 45 to 2=0.0%); and
    • 2=0.0%).

Limitations

  • Only CREDENCE was specifically powered for renal outcomes.

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