The primary preventive effect of sodium–glucose cotransporter inhibitors on chronic kidney disease in patients with type 2 diabetes: a systematic review and meta-analysis

TL;DR

This study finds that SGLT2 inhibitors significantly reduce the risk of developing chronic kidney disease in type 2 diabetes patients without existing kidney disease.

Contribution

The study provides the first meta-analysis on the primary preventive effect of SGLT2 inhibitors for chronic kidney disease in type 2 diabetes patients.

Findings

SGLT2 inhibitors reduced CKD-related outcomes by 53% in randomized controlled trials.

Observational data showed a lower CKD incidence with SGLT2 inhibitors compared to other therapies.

Low heterogeneity was observed in the meta-analysis of RCTs.

Abstract

To assess the efficacy of Sodium–glucose cotransporter inhibitors (SGLTis) in the primary prevention (PP) of chronic kidney disease (CKD) among patients with type 2 diabetes (T2D).

Literature was retrieved from MEDLINE, Embase, and Cochrane databases up to January 1, 2025. Eligible studies included randomized controlled trials (RCTs) or their subgroups and observational studies involving T2D patients without CKD treated with SGLTis for ≥ 1 year, focusing on CKD-related composite outcomes. Seven articles meeting inclusion criteria were included. The hazard ratio (RR) was calculated, and the degree of heterogeneity was assessed. Subsequently, 95% confidence intervals (95% CI) were computed accordingly.

In RCTs, 15,228 eligible participants received SGLTis and 12,736 received placebo. Meta-analysis using random-effects models showed that SGLTis reduced CKD-related composite outcomes by 53% (RR 0.47, 95% CI 0.39, 0.57; P < 0.0001) with low heterogeneity (I² = 6%). Observational data also indicated a lower CKD incidence (0.6–0.7%) with SGLTis versus other glucose-lowering therapies in individuals with CKD PP.

SGLTis significantly lower CKD incidence in T2D patients without baseline CKD. Further RCTs are necessary to validate our conclusions.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251168634.

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