SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria

作者：Brendon L. Neuen, Robert A. Fletcher, Stefan D. Anker, Deepak L. Bhatt, Javed Butler, David Z.I. Cherney, Kieran F. Docherty, Silvio E. Inzucchi, Meg Jardine, Kenneth W. Mahaffey, Finnian R. Mc Causland, Darren K. McGuire, John J.V. McMurray, Bruce Neal, Milton Packer, Siddharth M. Patel, Vlado Perkovic, Marc S. Sabatine, Rebecca J. Sardell, Scott D. Solomon, Muthiah Vaduganathan, C. Wanner, David C. Wheeler, Faïez Zannad, Richard Haynes, Natalie Staplin, William G. Herrington, Hiddo J.L. Heerspink, 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, Milton Packer, Siddharth M. Patel, Vlado Perkovic, Marc S. Sabatine, Natalie Staplin, Scott Solomon, Muthiah Vaduganathan, Christoph Wanner, David C. Wheeler, Faiez Zannad · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.20834 · 被引用次数：68 · 研究领域：Chronic Kidney Disease and Diabetes、Diabetes Treatment and Management、Renal Diseases and Glomerulopathies

Importance: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce chronic kidney disease (CKD) progression in individuals with type 2 diabetes, CKD, or heart failure. However, their effects in those with stage 4 CKD or little to no albuminuria remain uncertain. Objective: To assess whether estimated glomerular filtration rate (eGFR) or degree of albuminuria, measured by urinary albumin to creatinine ratio (UACR), modifies the effects of SGLT2 inhibitors on kidney outcomes. Data Sources: SGLT2 inhibitor trials participating in the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium (SMART-C). Study Selection: Randomized, double-blind, placebo-controlled trials within SMART-C evaluating an SGLT2 inhibitor with label indications for reducing CKD progression including at least 500 participants in each group with at least 6 months of follow-up. Data Extraction and Synthesis: Treatment effects in individual trials were pooled using inverse variance-weighted meta-analysis. Main Outcomes and Measures: CKD progression, defined as kidney failure, at least 50% reduction in eGFR, or death due to kidney failure. Other outcomes included annual rate of eGFR decline and kidney failure. Results: Among 70 361 participants (mean [SD] age, 64.8 [8.7] years; 24 595 [35.0%] females) in 10 randomized trials, 2314 (3.3%) experienced CKD progression and 988 (1.4%) reached kidney failure. SGLT2 inhibitors reduced the risk of CKD progression (25.4 vs 40.3 events per 1000 patient-years; ...