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이달의 kcj Hot Article / 2024년 9월
Cardiovascular Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Updated Meta-Analysis
저자 Nicole Felix,1Mateus M. Gauza, MD,2 Larissa Teixeira, MD,1 Maria Eduarda S. Guisso, MD,2 Alleh Nogueira,3 Caroline S. Dagostin, MD, MSc,
4 Amanda Godoi, BSc,5 Sandro A. G. Ribeiro, MD,6 Juan C. Duque, MD,7 José A. Moura-Neto, MD, FASN, FRCP,3 and Rhanderson Cardoso, MD, MHS, FACC8
소속 1Federal University of Campina Grande, Campina Grande, PB, Brazil.
2University of the Region of Joinville, Joinville, SC, Brazil.
3Bahiana School of Medicine and Public Health, Salvador, BA, Brazil.
4University of the Extreme South of Santa Catarina, Criciúma, SC, Brazil.
5Cardiff University School of Medicine, Cardiff, UK.
6University of Brasília, Brasília, DF, Brazil.
7Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miami, FL, USA.
8Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.

Background and Objectives

The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).

Methods

This systematic review and updated meta-analysis of randomized controlled trials (RCTs) compared cardiovascular outcomes of patients with T2DM and CKD treated with SGLT2i to placebo. PubMed, Embase, and Cochrane were systematically searched. Prespecified subgroup analyses were performed in strata of estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m2 and 45 to 59 mL/min/1.73 m2.

Results

Nine RCTs comprising 29,146 patients were selected. Average follow-up ranged from 0.75 to 4.2 years. SGLT2i were shown to reduce the risk of all-cause mortality (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79–0.97; p=0.01), the composite of cardiovascular mortality or hospitalizations for heart failure (HHF: HR, 0.71; 95% CI, 0.65–0.78; p<0.001), cardiovascular mortality (HR, 0.86; 95% CI, 0.76–0.98; p=0.02), HHF (HR, 0.62; 95% CI, 0.55–0.71; p<0.001), major adverse cardiovascular events (HR, 0.85; 95% CI, 0.77–0.94; p=0.002), stroke (HR, 0.76; 95% CI, 0.59–0.97; p=0.03), and myocardial infarction (HR, 0.78; 95% CI, 0.67–0.91; p=0.001). These findings were consistent over strata of eGFR, albeit with a lower incidence of stroke in patients treated with SGLT2i with eGFR <45 mL/min/1.73 m2 (p-value for interaction=0.04).

Conclusions

Compared with a placebo, patients with T2DM and CKD treated with SGLT2i experience a reduction in all-cause mortality, cardiovascular mortality, and HHF.

Trial Registration

PROSPERO Identifier: CRD42023401081
첨부파일1 KCJ-23-241_GA.jpg KCJ-23-241_GA.jpg (다운 75회)
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