Efficacy and safety of drugs for people with type 2 diabetes mellitus and chronic kidney disease on kidney and cardiovascular outcomes: A systematic review and network meta-analysis of randomized controlled trials

Yang, Q; Lang, Y; Yang, W; Yang, F; Yang, J; Wu, Y; Xiao, X; Qin, C; Zou, Y; Zhao, Y; Kang, D; Liu, F

doi:10.1016/j.diabres.2023.110592

Type 2 & other diabetes

Efficacy and safety of drugs for people with type 2 diabetes mellitus and chronic kidney disease on kidney and cardiovascular outcomes: A systematic review and network meta-analysis of randomized controlled trials

Diabetes Res Clin PractPublished 25 Feb 2023Systematic review and network meta-analysis of randomised controlled trials

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Authors' conclusion

SGLT-2Is significantly reduced kidney and cardiovascular risk in T2DM and CKD, subsequently GLP-1RAs and MRAs. SGLT-2Is-MRAs combination might be a recommended treatment regimen for maximizing kidney and cardiovascular protection but with a low risk of hyperkalemia in T2DM and CKD.

Study context

Population: People with T2D and chronic kidney disease (CKD)
Participants: 50,237 people27 trials

Comparison: Kidney protection drugs in T2D and CKD
Outcome: Composite kidney events

Methodological detailsBayesian model, PubMed, Embase and Cochrane Library searched from inception to August 12, 2022

Bayesian model
PubMed, Embase and Cochrane Library searched from inception to August 12, 2022

Pooled result

As reported in the abstract

Group	RR (95% CI)
SGLT-2Is	0.69 (0.61-0.79)
MRAs	0.77 (0.68-0.88)
GLP-1RAs	0.78 (0.62-0.97)
Endothelin receptor antagonist (ERAs)	0.75 (0.57-0.99)

RR (95% CI)

SGLT-2Is0.69 (0.61-0.79)

MRAs0.77 (0.68-0.88)

GLP-1RAs0.78 (0.62-0.97)

Endothelin receptor antagonist (ERAs)0.75 (0.57-0.99)

Further pooled results

Outcome	Values
eGFR slope	SGLT-2Is MD (95% CI) 1.34 (1.06-1.62) · MRAs MD (95% CI) 1.31 (0.89-1.74) · GLP-1RAs MD (95% CI) 0.75 (0.46-1.05) · ERAs MD (95% CI) 0.7 (0.3-1.1)
HF hospitalization	SGLT-2Is RR (95% CI) 0.67 (0.57-0.78) · GLP-1RAs RR (95% CI) 0.73 (0.55-0.97) · MRAs RR (95% CI) 0.79 (0.67-0.92)
MACE	SGLT-2Is RR (95% CI) 0.8 (0.71-0.89) · GLP-1RAs RR (95% CI) 0.72 (0.6-0.86)

MACE

SGLT-2Is and GLP-1RAs had comparable effects

Safety

Outcome	Values
Drug discontinuation due to adverse events	MRAs RR (95% CI) 1.21 (1.05-1.38)
Hyperkalemia	MRAs RR (95% CI) 2.08 (1.86-2.33) · SGLT-2Is RR (95% CI) 0.78 (0.65-0.93)

Reference

Authors: Yang Q, Lang Y, Yang W, Yang F, Yang J, Wu Y, et al.
All 12 authors
Yang Q, Lang Y, Yang W, Yang F, Yang J, Wu Y, Xiao X, Qin C, Zou Y, Zhao Y, Kang D, Liu F
Journal: Diabetes Research and Clinical Practice
Published: 25 Feb 2023
DOI: 10.1016/j.diabres.2023.110592
PubMed: 36842477
Registration: CRD42022343601

Topic: Type 2 & other diabetes

Comparison

Kidney protection drugs (SGLT2i, GLP-1 RA, DPP-4i, MRAs, ERAs, pentoxifylline, pirfenidone) in T2D and CKD

Group definitions

SGLT-2Is: sodium-glucose cotransporter-2 inhibitors
GLP-1RAs: glucagon-like peptide-1 receptor agonists
DPP-4Is: dipeptidyl-peptidase IV inhibitors
MRAs: aldosterone receptor agonists
ERAs: endothelin receptor antagonist

Key notes

SGLT-2Is optimal in reducing composite kidney events; then MRAs, GLP-1RAs and ERAs in parallel
Moderate to high quality

Original publication

Efficacy and safety of drugs for people with type 2 diabetes mellitus and chronic kidney disease on kidney and cardiovascular outcomes: A systematic review and network meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. Published 25 February 2023. doi:10.1016/j.diabres.2023.110592

Read the original article ↗

Composed by AI from the published abstract and checked against it. How Briefs are made →