Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria

作者：Natalie Staplin, Alistair Roddick, Brendon L. Neuen, Stefan D. Anker, Deepak L. Bhatt, Javed Butler, David Z.I. Cherney, Kieran F. Docherty, Robert A. Fletcher, Silvio E. Inzucchi, Meg Jardine, Kenneth W. Mahaffey, Darren K. McGuire, John J.V. McMurray, Bruce Neal, Milton Packer, Siddharth M. Patel, Vlado Perkovic, Marc S. Sabatine, Scott Solomon, Muthiah Vaduganathan, Christoph Wanner, David C. Wheeler, Faı̈ez Zannad, Richard Haynes, Hiddo J.L. Heerspink, William G. Herrington, Brendon L. Neuen, Hiddo JL Heerspink, Stefan D. Anker, Deepak L. Bhatt, Javed Butler, David Z.I. Cherney, Kieran F. Docherty, Adrian F. Hernandez, William G. Herrington, Silvio E. Inzucchi, Stefan James, Meg Jardine, Kenneth W. Mahaffey, Darren K. McGuire, John J.V. McMurray, Bruce Neal, Siddharth M. Patel, Vlado Perkovic, Marc S. Sabatine, Natalie Staplin, Scott D. Solomon, Muthiah Vaduganathan, Christoph Wanner, David C. Wheeler, Faı̈ez Zannad · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.20835 · 被引用次数：16 · 研究领域：Diabetes Treatment and Management、Chronic Kidney Disease and Diabetes、Pancreatic function and diabetes

Importance: There is uncertainty about the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors in participants with chronic kidney disease, with guidelines offering different strengths of recommendation based on diabetes status and urine albumin to creatinine ratio (UACR). Objective: To assess the relative and absolute effects of SGLT2 inhibitor use across efficacy and serious safety outcomes in participants stratified by diabetes status and UACR (≥200 mg/g or <200 mg/g). Data Sources and Study Selection: Included 8 randomized clinical trials that studied an SGLT2 inhibitor with a label indication for use in kidney disease and recorded longitudinal kidney outcomes and baseline data on albuminuria. Data Extraction and Synthesis: Data were combined using inverse variance-weighted meta-analysis; group-specific absolute effects were estimated by applying relevant relative risks to the event rates of the placebo groups. Main Outcomes and Measures: Assessed the effects of SGLT2 inhibitor use on clinical efficacy and safety outcomes. Heterogeneity by baseline level of UACR was assessed separately by diabetes status. Results: A total of 58 816 participants (mean age, 64 [SD, 10] years; 35% were female; 48 946 with diabetes and 9870 without diabetes) were included from trials comparing an SGLT2 inhibitor vs placebo. Allocation to an SGLT2 inhibitor produced a lower rate of kidney disease progression (33 vs 48 for placebo per 1000 patient-years; hazard ratio [HR], 0.65 [95% CI...