- 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
- New Living Standards of Care from the American Diabetes Association incorporate SGLT2 inhibitors for patients with diabetic kidney disease.
- Findings “strongly support the notion that SGLT2 inhibitors offer kidney protection to a broad range of patients with type 2 diabetes, including those with both preserved and low renal function,” Richard E. Gilbert, MD, PhD writes in an accompanying comment.
- 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.
- 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
- Only CREDENCE was specifically powered for renal outcomes.