Impact of sodium-glucose co-transporter 2 inhibitors on renal outcomes in patients of diabetes mellitus: A meta-analysis of landmark renal and cardiovascular outcome trials

Sodium-glucose co-transporter 2 inhibitors (SGLT2is) are recommended as the next step therapy for the management of diabetes mellitus. The large clinical trials of SGLT2is demonstrated benefits on various renal endpoints. We conducted this meta-analysis of large trials on cardiovascular and renal safety trials to explore the renoprotective effect of this group of drugs. PubMed, Cochrane CENTRAL, and EMBASE databases were searched with specific keywords till January 19, 2021. Randomized trials of SGLT2is that evaluated the cardiovascular or renal composite outcome as a primary outcome measure were eligible. Random-effects model was used to calculate the overall risk ratios. The search yielded 716 studies and 10 studies were included. The SGLT2is reduced the risk of composite renal outcome (risk ratio [RR] = 0.64, 95% confidence interval [CI] = 0.58–0.72), decline in estimated glomerular filtration rate (eGFR) (RR = 0.62, 95% CI = 0.50–0.77), doubling of serum creatinine (RR = 0.67, 95% CI = 0.56–0.81), dialysis or renal replacement therapy (RR = 0.71, 95% CI = 0.59–0.86), sustained eGFR of <15 ml per min per 1.73 m(2) for at least 30 days or more (RR = 0.66, 95% CI = 0.55–0.81), end-stage renal disease (RR = 0.70, 95% CI = 0.56–0.87), and acute kidney injury (RR = 0.79, 95% CI = 0.71–0.89). This analysis establishes the renoprotective effect of SGLT2is. This benefit is noted in patients who had eGFR of more or <60 ml per min per 1.73 m(2). This benefit was uniform across all the SGLT2 inhibitors except ertugliflozin and sotagliflozin.