SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis
| Autor: | David M. Charytan, Severine Bompoint, Adeera Levin, Clare Arnott, Bruce Neal, Laurent Billot, Kenneth W. Mahaffey, David C. Wheeler, Brendon L. Neuen, Vlado Perkovic, Meg Jardine, Hiddo J.L. Heerspink, Tamara Young |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
NEPHROPATHY Endocrinology Diabetes and Metabolism medicine.medical_treatment Renal function PROGRESSION 030209 endocrinology & metabolism Type 2 diabetes DISEASE 1117 Public Health and Health Services MECHANISMS Nephropathy Endocrinology & Metabolism MELLITUS 03 medical and health sciences 0302 clinical medicine Endocrinology Internal medicine Internal Medicine medicine Humans Diabetic Nephropathies 030212 general & internal medicine Sodium-Glucose Transporter 2 Inhibitors Dialysis Randomized Controlled Trials as Topic RISK OUTCOMES Science & Technology business.industry EMPAGLIFLOZIN GLOMERULAR HYPERFILTRATION Acute kidney injury 1103 Clinical Sciences medicine.disease Transplantation CONVERTING ENZYME-INHIBITORS 1101 Medical Biochemistry and Metabolomics Albuminuria Kidney Failure Chronic medicine.symptom business Life Sciences & Biomedicine Kidney disease |
| Zdroj: | The Lancet Diabetes & Endocrinology. 7:845-854 |
| ISSN: | 2213-8587 |
| DOI: | 10.1016/s2213-8587(19)30256-6 |
| Popis: | Background The effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors on kidney failure, particularly the need for dialysis or transplantation or death due to kidney disease, is uncertain. Additionally, previous studies have been underpowered to robustly assess heterogeneity of effects on kidney outcomes by different levels of estimated glomerular filtration rate (eGFR) and albuminuria. We aimed to do a systematic review and meta-analysis to assess the effects of SGLT2 inhibitors on major kidney outcomes in patients with type 2 diabetes and to determine the consistency of effect size across trials and different levels of eGFR and albuminuria. Methods We did a systematic review and meta-analysis of randomised, controlled, cardiovascular or kidney outcome trials of SGLT2 inhibitors that reported effects on major kidney outcomes in people with type 2 diabetes. We searched MEDLINE and Embase from database inception to June 14, 2019, to identify eligible trials. The primary outcome was a composite of dialysis, transplantation, or death due to kidney disease. We used random-effects models to obtain summary relative risks (RRs) with 95% CIs and random-effects meta-regression to explore effect modification by subgroups of baseline eGFR, albuminuria, and use of renin–angiotensin system (RAS) blockade. This review is registered with PROSPERO (CRD42019131774). Findings From 2085 records identified, four studies met our inclusion criteria, assessing three SGLT2 inhibitors: empagliflozin (EMPA-REG OUTCOME), canagliflozin (CANVAS Program and CREDENCE), and dapagliflozin (DECLARE–TIMI 58). From a total of 38 723 participants, 252 required dialysis or transplantation or died of kidney disease, 335 developed end-stage kidney disease, and 943 had acute kidney injury. SGLT2 inhibitors substantially reduced the risk of dialysis, transplantation, or death due to kidney disease (RR 0·67, 95% CI 0·52–0·86, p=0·0019), an effect consistent across studies (I2=0%, pheterogeneity=0·53). SGLT2 inhibitors also reduced end-stage kidney disease (0·65, 0·53–0·81, p |
| Databáze: | OpenAIRE |
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