Renal protective effect and safety of sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease and type 2 diabetes mellitus: a network meta-analysis and systematic review.

Abstract

A network meta-analysis was conducted to evaluate the renal protective effect and safety of sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease and type 2 diabetes mellitus. PubMed, Embase, Cochrane Library, and Web of Science were searched by two authors using the Cochrane Collaboration risk of bias tool. Compared with controls, luseogliflozin 2.5mg (MD = -3.50, 95% CI -6.65 to -0.35), bexagliflozin 20mg (MD = -3.48, 95% CI -6.57 to -0.39), and dapagliflozin 10mg (MD = -3.08, 95% CI -5.09 to -1.06) reduced the estimated glomerular filtration rate (eGFR). Empagliflozin 25mg (MD = -240.43, 95% CI -414.13 to -66.73), dapagliflozin 10mg (MD = -94.15, 95% CI -111.72 to -76.59), and canagliflozin 100mg (MD = -193.25, 95% CI -279.16 to -107.34) reduced urine albumin-creatinine ratio levels compared with controls. Empagliflozin 25mg, canagliflozin 100mg and dapagliflozin 10mg induced a significant decline in urine albumin-creatinine ratio compared to dapagliflozin 5mg. In terms of safety, ertugliflozin 5mg reduced the risk of urinary tract infection. Compared with controls, empagliflozin 10mg and 25mg, and canagliflozin 100mg reduced the risk of any adverse events while canagliflozin 100mg reduced the risk of serious adverse events. Dapagliflozin 10mg had a lower risk of treatment discontinuation. Sodium-glucose cotransporter-2 inhibitors have favourable renal protective effect and safety; however, additional randomised clinical trials are needed to validate these findings.