Impact of baseline kidney function on the effects of sodium‐glucose co‐transporter‐2 inhibitors on kidney and heart failure outcomes: A systematic review and meta‐analysis of randomized controlled trials
Authors' conclusion
SGLT2is reduce the risk of renal and HF outcomes for all eGFR categories. The greatest benefits in terms of kidney protection may be achieved by early initiation of SGLT2is in people with preserved eGFR. The greatest risk reduction for HF outcomes is observed in people with lower eGFR values.
Study context
- Population
- Participants in RCTs of SGLT2is on renal and cardiovascular outcomes, with available estimated glomerular filtration rate (eGFR) data
- Participants
- 90,402 participants13 RCTs
- Comparison
- SGLT2i vs placebo, by baseline eGFR category
- Outcome
- Renal disease progression, composite HF outcome and mortality, stratified by baseline eGFR category
Methodological detailsplacebo-controlled trials, meta-regression, stratified by baseline eGFR, Risk of bias judged low for all trials
- Placebo-controlled trials
- Meta-regression
- Stratified by baseline eGFR
- Risk of bias judged low for all trials
Pooled result
As reported in the abstract
Renal disease progression by baseline eGFR
SGLT2is vs PlaceboHazard ratio (95% CI)P value
eGFR ≥90 ml/min/1.73m2
0.43(0.32–0.58)
eGFR <30 ml/min/1.73m2
0.73(0.62–0.86)
P < 0.001- Relative risk reduction across eGFR categories
- 27% to 57%
- Meta-regression: significant direct relationship between baseline eGFR and magnitude of renal protection
- P = 0.003
Further pooled results
Composite heart failure (HF) outcome by baseline eGFR category
- SGLT2is reduced relative risk of HF outcomes across eGFR categories, overall low heterogeneity
- 13% to 32%
- Greatest HF risk reduction: eGFR <30 ml/min/1.73m2, HR
- 0.68 (95% CI 0.48-0.96)
- Smallest HF risk reduction: eGFR ≥90 ml/min/1.73m2, HR
- 0.87 (95% CI 0.56-1.34)
Original publication
Impact of baseline kidney function on the effects of sodium‐glucose co‐transporter‐2 inhibitors on kidney and heart failure outcomes: A systematic review and meta‐analysis of randomized controlled trials. Diabetes Obes Metab. Published 14 February 2023. doi:10.
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