Abstract
Chronic kidney disease (CKD) and cardiovascular disease share common risk factors such as hypertension, diabetes mellitus and dyslipidemia. Patients with CKD carry a high burden of cardiovascular disease and may be excluded from clinical trials on the basis of safety. There are an increasing number of clinical trials which predefine sub-group analysis for CKD. This systematic review with fixed-effect meta-analysis investigates glucose lowering therapy and cardiovascular outcomes in relation to CKD. We included randomized controlled trials (RCT) of glucose lowering treatments performed in adults (aged ≥18 years), humans, with no restriction on date, and English-language restriction in patients with pre-existing CKD regardless of diabetes status. Embase & Ovid Medline databases were searched up to April 2021. Risk of bias was assessed according to Revised Cochrane risk-of-bias tool. We included 7 trials involving a total of 48,801 participants. There were 4 sodium-glucose cotransporter-2 inhibitors (SGLT2i), 2 glucagon-like peptide-1 receptor (GLP-1R) agonists and 1 Dipeptidyl-peptidase 4 (DPP4) inhibitor identified. SGLT2i (relative risk (RR) = 0.90, 95% confidence interval (CI) [0.79-1.02]) and GLP-1R agonists (RR = 0.83, 95% CI [0.72-0.96]) were associated with a reduction in cardiovascular death. SGLT2i (RR = 0.69, 95% CI [0.63-0.75]) are also associated with a reduction in hospitalization for heart failure. In summary, this meta-analysis of large, RCTs of glucose lowering therapies has demonstrated that treatment with SGLT2i or GLP-1R agonists may improve 3 point-MACE and cardiovascular outcomes in patients with chronic renal failure compared with placebo. This systematic review was registered with the PROSPERO network (registration number: CRD42021268563) and follows the PRISMA guidelines on systematic reviews and metanalysis.
Highlights
Cardiac dysfunction in the presence of chronic kidney disease (CKD) is a well-established phenomenon
Sixty-seven studies were identified as randomized controlled trials (RCT) with cardiovascular outcomes which involved CKD patients
In patients with CKD, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor (GLP1R) agonists were associated with a reduction in cardiovascular death and all-cause death, and SGLT2i, GLP1R agonists and Dipeptidyl-peptidase 4 (DPP4) inhibitors were associated with a reduction in hospitalization for heart failure
Summary
Cardiac dysfunction in the presence of chronic kidney disease (CKD) is a well-established phenomenon. End-stage renal disease (ESRD) is associated with adverse cardiac events in up to 64% of patients undergoing hemodialysis. Developing evidence-based medicines for cardiovascular disease (CVD) through randomized, controlled trials (RCTs) in this population is a current priority [1, 2]. Cardiovascular death accounts for 50% of deaths in CKD patients representing an unmet clinical therapeutic need for safe and effective therapies in these patients [2]. Many of the risk factors of cardiac dysfunction and CKD are shared, including hypertension, diabetes mellitus, dyslipidemia, and coronary artery disease [3]. ; anemia, hypovolemia, proteinuria and mineral metabolism abnormalities associated with CKD are associated with increased likelihood of adverse cardiovascular outcomes [3]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
