Abstract
AimThis study investigated the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on renal outcomes in Asian patients with type 2 diabetes mellitus (T2DM).Materials and methodsWe searched Medline, EMBASE, and the Cochrane Library to identify randomized controlled trials published up to April 2020 that compared SGLT2 inhibitors with placebo or active comparator and reported any renal outcomes in Asian patients with T2DM. Random effects models and inverse variance weighting were used to calculate relative risks with 95% confidence intervals (CIs).ResultsWe included 14 studies, totaling 3792 patients, in the analysis. In the short term, SGLT2 inhibitors significantly slowed estimated glomerular filtration rate (eGFR) decline (MD: 0.80; 95% CI: 0.66 to 0.94; p < 0.00001) and reduced Scr levels (SMD: − 0.17; 95% CI: − 0.23 to − 0.10; p < 0.00001) as compared with the control groups. The SGLT2 inhibitor group also had an advantage over the control group in lowering uric acid (UA) (SMD: − 1.2; 95% CI: − 1.30 to − 1.11; p < 0.00001). There was no significant difference in urinary albumin creatinine ratio (UACR) reduction between the SGLT2 inhibitor and control groups (MD: − 8.87; 95% CI: − 19.80 to 2.06; p = 0.11). However, dapagliflozin does appear to reduce albuminuria (p = 0.005). Lastly, SGLT2 inhibitors increased the incidence of adverse events (AEs) related to renal function (OR: 1.90; 95% CI: 1.24 to 2.91; p = 0.003), but did not increase the incidence of renal impairment (OR: 0.85; 95% CI: 0.40 to 1.81; p = 0.68).ConclusionThe use of SGLT2 inhibitors in Asian patients with T2DM can help delay the decline of eGFR and reduce Scr and UA. Although SGLT2 inhibitors have no overall advantage in reducing albuminuria, dapagliflozin does appear to reduce albuminuria, and while they may increase the occurrence of AEs related to renal function, they do not increase the incidence of renal impairment.
Highlights
According to the International Diabetes Federation (IDF), the number of patients with diabetes reached 451 million worldwide in 2017
This study is a systematic review and meta-analysis that evaluated the effects of Sodium-glucose cotransporter 2 (SGLT2) inhibitors on the renal outcomes of Asian patients with type 2 diabetes mellitus (T2DM) as compared with placebo or positive controls
There was no significant difference in the reduction of urinary albumin creatinine ratio (UACR) between the SGLT2 inhibitor and control groups (MD: − 8.87; 95% confidence intervals (CIs): − 19.80 to 2.06; p = 0.11; Fig. 10)
Summary
According to the International Diabetes Federation (IDF), the number of patients with diabetes reached 451 million worldwide in 2017. Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the glucose reabsorption capacity of the kidney by inhibiting glucose transporters on the surface of the proximal tubules of the kidney, thereby promoting the excretion of urinary glucose [4]. Studies from across the globe have shown that SGLT2 inhibitors are beneficial to the cardiovascular and renal outcomes of patients with T2DM [5]. Asians are at high risk of DKD, meta-analyses focused on this population are lacking. We performed a systematic review and International Journal of Diabetes in Developing Countries meta-analysis of randomized controlled trials (RCTs) to investigate the effects of SGLT2 inhibitors on renal outcomes in Asian patients with T2DM
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