Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline

作者：Arnav Agarwal, Xiaoxi Zeng, Sheyu Li, Daniel G. Rayner, Farid Foroutan, Bert Aertgeerts, Frederic Coyac, Pauline Darbellay Farhoumand, Andrew Glenn Demaine, Anja Fog Heen, Vivekanand Jha, Edward Machuve, Evi Nagler, David J. Tunnicliffe, Gordon H Guyatt, Per Olav Vandvik, Belén Ponte, Thomas Agoritsas · 发表于：BMJ · 年份：2024 · DOI：10.1136/bmj-2024-080257 · 被引用次数：31 · 研究领域：Diabetes Treatment and Management、Chronic Kidney Disease and Diabetes、Potassium and Related Disorders

CLINICAL QUESTION: What is the impact of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on survival and on cardiovascular and kidneyoutcomes for adults living with chronic kidney disease (CKD)? CURRENT PRACTICE: Few therapies slow kidney disease progression and improve long term prognosis for adults living with CKD. SGLT-2 inhibitors have demonstrated cardiovascular and kidney benefits in adults with CKD with and without type 2 diabetes. Existing guidance for SGLT-2 inhibitors does not account for the totality of current best evidence for adults with CKD and does not provide fully stratified treatment effects and recommendations across all risk groups based on risk of CKD progression and complications. RECOMMENDATIONS: The guideline panel considered evidence regarding benefits and harms of SGLT-2 inhibitor therapy for adults with CKD over a five year period, along with contextual factors, and provided the following recommendations:1. For adults at low risk of CKD progression and complications, we suggest administering SGLT-2 inhibitors (weak recommendation in favour)2. For adults at moderate risk of CKD progression and complications, we suggest administering SGLT-2 inhibitors (weak recommendation in favour)3. For adults at high risk of CKD progression and complications, we recommend administering SGLT-2 inhibitors (strong recommendation in favour)4. For adults at very high risk of CKD progression and complications, we recommend administering SGLT-2 inhibitors (strong reco...