In a collaborative meta-analysis of large placebo-controlled trials, SGLT2 inhibitors had beneficial effects on patients with chronic kidney disease or heart failure irrespective of diabetes status, primary kidney disease, or kidney function. “This meta-analysis provides high-quality evidence to support guideline recommendations for the use of SGLT2 inhibitors as a foundational therapy to reduce the risk of kidney disease progression and acute kidney injury not only in patients with type 2 diabetes at high cardiovascular risk, but also in patients who have chronic kidney disease or heart failure, irrespective of diabetes status, primary kidney diagnosis, or level of kidney function,” the authors conclude.
“Compared with placebo, allocation to an SGLT2 inhibitor reduced the risk of kidney disease progression by 37% (relative risk [RR] 0.63, 95% CI 0.58–0.69) with similar RRs in patients with and without diabetes,” the investigators wrote of the 90,409 participants they included from 13 trials. “In the four chronic kidney disease trials, RRs were similar irrespective of primary kidney diagnosis. SGLT2 inhibitors reduced the risk of acute kidney injury by 23% (0.77, 0.70–0.84) and the risk of cardiovascular death or hospitalisation for heart failure by 23% (0.77, 0.74–0.81), again with similar effects in those with and without diabetes. SGLT2 inhibitors also reduced the risk of cardiovascular death (0.86, 0.81–0.92) but did not significantly reduce the risk of non-cardiovascular death (0.94, 0.88–1.02). For these mortality outcomes, RRs were similar in patients with and without diabetes. For all outcomes, results were broadly similar irrespective of trial mean baseline eGFR. Based on estimates of absolute effects, the absolute benefits of SGLT2 inhibition outweighed any serious hazards of ketoacidosis or amputation.”