The Effectiveness And Safety Of SGLT2 Inhibitors In Diabetic And Non-diabetic Chronic Kidney Disease:A Meta-analysis

Objective:To investigate the effects of SGLT2 inhibitors on blood glucose,blood pressure,body weight,renal function and adverse events in patients of type 2 diabetes mellitus(T2DM)with chronic kidney dis-ease(CKD);and to explore the impact of SGLT2 inhibitors on the inc-idence of chronic kidney disease patients with or without type 2 diabet-es mellitus with e GFR decreased by 50%,end stage renal disease and death from kidney disease.Methods:The papers were searched for the results of SGLT2 inhi-bitors on T2DM with CKD and non-diabetic chronic kidney disease pat-ients in Pub Med,Embase,Cochrane,and Web of Science databases by the date of November 30,2020.Rev Man5.3 and State15.1 software we-re used for meta-analysis.And the I~2 value was used to test the hetero-geneity among the studies.Statistical significance was accepted at the P<0.05 level.Results:A total of 12 randomized controlled trials(RCTs)were i-ncluded,with a total of 14147 participants.Meta-analysis showed that in patients with T2DM and CKD,SGLT2 inhibitors could effectively r-educe glycosylated hemoglobin[MD=-0.30,95%CI(-0.37,-0.22),P<0.00001],body weight[MD=-1.97,95%CI(-2.22,-1.73),P<0.00001],systolic blood pressure[MD=-5.19,95%CI(-6.08,-4.31),P<0.00001],diastolic blood pressure[MD=-4.12,95%CI(-4.63,-3.60),P<0.00001]and urine albumin/creatinine[MD=-20.69,95%CI(-38.41,-2.97),P=0.02].But they had no significant effect on e GFR[MD=-0.76,95%CI(-1.61,0.09),P=0.08].For adverse events such as urinary tract infection[RR=1.14,95%CI(1.00,1.29),P=0.05]and acute kidney injury[RR=0.85,95%CI(0.72,1.00),P=0.05],SGLT2 inhibitors h-ad no obvious effect.However,they increased the risk of reproductive tract infection[RR=3.02,95%CI(2.31,3.95),P<0.00001].In patie-nts with type 2 diabetes with chronic kidney disease and non-diabetic chronic kidney disease,the incidence of e GFR decline by 50%[RR=0.59,95%CI(0.50,0.69),P<0.00001]and end stage renal disease[RR=0.69,95%CI(0.59,0.81),P<0.00001]could be reduced by SGLT2inhibitors,not for the incidence of death from kidney disease[RR=0.64,95%CI(0.25,1.64),P=0.35].Conclusions:Compared with placebo,SGLT2 inhibitors show pote-ntial renal protection and fewer adverse events in patients of chronic ki-dney disease with and without type 2 diabetes mellitus.We are looking forward for further research and exploration for SGLT2 inhibitors whi-ch can improve the progression of chronic kidney disease and reduce the burden on society.