- This meta-analysis suggests that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may lower the odds for acute kidney injury (AKI) in patients with diabetes mellitus.
Why this matters
- Findings indicate that fear of causing AKI should not stop practitioners prescribing SGLT2is.
- Systematic review and meta-analysis of 112 randomised trials (n=96,777) and 5 observational cohorts (n=83,934).
- The effect of SGLT2-inhibitors on renal adverse events (AEs) was assessed (most patients had type 2 diabetes).
- Funding: None.
- Overall, 41 trials identified 1089 AKI AEs.
- 410 AKI-related serious AEs (SAEs) were reported in 30 randomised trials (n=58,181).
- SGLT2is diminished the odds for an SAE AKI by 36% (OR, 0.64; P<.001 dapagliflozin p and empagliflozin had comparable effect size.>
- The number of AKI events noted in SGLT2i (n=38,441) vs placebo (n=29,718) arm: 550 vs 539 events.
- Overall, SGLT2is had a positive effect, with an odds reduction of 25% (OR, 0.75; P<.001 with no detectable heterogeneity.>
- Volume-depletion-related AEs were more common in the SGLT2i-treated patients (OR, 1.20; P<.001>
- A positive effect of SGLT2is on adverse renal events was also noted from observational studies (OR, 0.40; P<.001>
- The safety endpoints were not validated by an endpoint committee.
- Some studies may have under-reported AKI events.