Efficacy and safety of sodium glucose cotransporter 2 inhibitors plus standard care in diabetic kidney disease: A systematic review and meta-analysis

被引:8
|
作者
Woodhams, Louise M. [1 ]
Chalmers, Leanne [1 ]
Sim, Tin Fei [1 ]
Yeap, Bu B. [2 ,3 ]
Schlaich, Markus P. [2 ,4 ,5 ,6 ,7 ]
Schultz, Carl [2 ,7 ]
Hillis, Graham S. [2 ,7 ]
机构
[1] Curtin Univ, Curtin Med Sch, Perth, WA, Australia
[2] Univ Western Australia, Med Sch, Perth, WA, Australia
[3] Fiona Stanley Hosp, Dept Endocrinol & Diabet, Perth, WA, Australia
[4] Univ Western Australia, Royal Perth Hosp Unit, Med Res Fdn, Dobney Hypertens Ctr,Med Sch, Perth, WA, Australia
[5] Royal Perth Hosp, Dept Nephrol, Perth, WA, Australia
[6] Baker Heart & Diabet Inst, Neurovasc Hypertens & Kidney Dis Lab, Melbourne, Vic, Australia
[7] Royal Perth Hosp, Dept Cardiol, Perth, WA, Australia
关键词
Diabetic kidney disease; Type; 2; diabetes; SGLT2; inhibitors; ACE inhibitors; ARBs; Urine albumin-creatinine ratio; CANAGLIFLOZIN CARDIOVASCULAR ASSESSMENT; BASE-LINE CHARACTERISTICS; TYPE-2; DAPAGLIFLOZIN; NEPHROPATHY; IRBESARTAN; RATIONALE; LOSARTAN; DESIGN;
D O I
10.1016/j.jdiacomp.2023.108456
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Many people with type 2 diabetes progress to end-stage diabetic kidney disease (DKD) despite blockade of the renin-angiotensin system, suggesting the need for innovative treatment options for DKD. To capture the findings of recent studies, we performed an updated systematic review and meta-analysis of the efficacy and safety of sodium glucose co-transporter 2 (SGLT2) inhibitors combined with standard care involving angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers (ARBs) on the development and progression of DKD in people with type 2 diabetes compared with standard care alone. Methods: The Cochrane Library, MEDLINE, EMBASE, PubMed and clinical trials registers were systematically searched for randomized controlled trials published before 1 September 2022. Primary outcomes were urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Secondary outcomes were glycated hemoglobin (HbA1c) and systolic blood pressure (SBP). Relative risk was calculated for adverse events. Results: Eight studies enrolling 5512 participants were included. In the meta-analysis (n = 1327), SGLT2 inhibitors were associated with a statistically significant reduction in UACR (weighted mean difference [WMD] -105.61 mg/g, 95 % CI -197.25 to -13.98, I2 = 99 %, p = 0.02). There was no statistically significant difference in relation to eGFR (n = 1375; WMD -0.23 mL/min/1.73m2, 95 % CI -4.34 to 3.89, I2 = 94 %, p = 0.91). Conclusions: SGLT2 inhibitors in addition to standard care including ACE inhibitors and/or ARBs significantly reduced albuminuria, HbA1c and SBP when compared to standard care alone, supporting their routine use in people with type 2 diabetes.
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页数:9
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