J Natl Med Assoc. 2025 Sep 16:S0027-9684(25)00304-9. doi: 10.1016/j.jnma.2025.08.110. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors in reducing the risk of acute kidney injury (AKI) in patients with chronic kidney disease (CKD), cardiovascular disease (CVD), and type 2 diabetes mellitus (T2DM).
METHODS: A meta-analysis were conducted on the randomized controlled trials (RCTs) comparing SGLT2 inhibitors with placebo in the incidence of AKI. Databases were searched for relevant studies up to September 23, 2024. The primary outcome was the occurrence of AKI.
RESULTS: There are 8 studies ultimately met the inclusion criteria. These studies encompassed a total of 65,606 patients, with 1,853 cases of AKI reported. The analysis demonstrated that SGLT2 inhibitors significantly reduced the risk of AKI compared to placebo (HR 0.78, CI 0.71-0.85, P < 0.001). In addition, subgroup analysis revealed that SGLT2 inhibitors effectively lowered the risk of AKI in patients with initial eGFR ≥ 60 mL/min/1.73 m² (HR 0.61, CI 0.42-0.88, P < 0.01) and eGFR < 60 mL/min/1.73 m² (HR 0.74, CI 0.58-0.94, P < 0.05). However, in patients with eGFR < 45 mL/min/1.73 m², there was no significant difference in AKI incidence between the SGLT2 inhibitor group and the placebo group (HR 1.04, CI 0.50-2.17, P = 0.91). In white or Asian patients, there was no significant difference in AKI incidence between the SGLT2 inhibitor group and the placebo group (0.75, CI 0.48-1.17, P = 0.21) and (0.97, CI 0.26-3.70, P = 0.96).
CONCLUSION: SGLT2 inhibitors significantly reduce the risk of AKI in patients with CKD, CVD, and T2DM, with greater efficacy observed in those with higher initial eGFR. However, when eGFR falls below 45 mL/min/1.73 m², SGLT2 inhibitors do not reduce the occurrence of AKI.
PMID:40962701 | DOI:10.1016/j.jnma.2025.08.110