aim to evaluate the effect of SGLT2 inhibitors on kidney outcomes across the Kidney Disease: Improving Global Outcomes (KDIGO) classification and urinary albumin-to-creatinine ratio (UACR) levels. Methods: We have searched MEDLINE (PubMed), EMBASE and the Cochrane Central Register of Controlled Trials from inception up to August 8th, 2023. In pairs, researchers selected large (≥500 subjects per arm) randomized placebo-controlled trials of SGLT2 inhibitors, with a minimum duration of one year. Researchers independently extracted study-level data and assessed within-study risk of bias with the RoB 2.0 tool and quality of evidence with GRADE. Results: We included 10 trials, encompassing 78,184 participants and a median follow-up of 2.7 years. Risk of bias was overall low. We performed meta-analyses summarizing individual study hazard ratios (HR) and 95% confidence intervals (CI) using a random-effects model. SGLT2 inhibitors reduced the composite kidney outcome across all KDIGO (HR [95% CI]: low 0.48 [0.32-0.71], moderate 0.60 [0.39-0.93], high 0.59 [0.47-0.74], very high 0.59 [0.49-0.72]) and UACR (HR [95% CI]: <30 mg/g 0.62 [0.50-0.78], ≥30 ≤300 mg/g 0.80 [0.67-0.96], >300 mg/g 0.61 [0.52-0.73]) groups, without evidence of heterogeneity between groups. Limitations: Small proportion of subjects without diabetes in low-risk groups and lack of standardization of composite outcomes. Conclusions: SGLT2 inhibitors consistently reduce kidney outcomes across the spectrum of KDIGO classes and UACR levels. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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SGLT2 抑制剂和各种肾脏疾病的肾脏结局：系统评价和荟萃分析


旨在评估 SGLT2 抑制剂对整个肾脏疾病的肾脏结局的影响：改善全球结局 (KDIGO) 分类和尿白蛋白肌酐比 (UACR) 水平。方法：我们检索了 MEDLINE (PubMed)、EMBASE 和 Cochrane 对照试验中心注册库，从开始到 2023 年 8 月 8 日。研究人员成对选择了 SGLT2 抑制剂的大型（每组≥500 名受试者）随机安慰剂对照试验，最短持续时间为一年。研究人员独立提取研究级数据，并使用 RoB 2.0 工具评估研究内偏倚风险，并使用 GRADE 评估证据质量。结果：我们纳入了 10 项试验，涉及 78,184 名参与者，中位随访时间为 2.7 年。总体而言，偏倚风险较低。我们使用随机效应模型进行荟萃分析，总结个别研究的风险比 (HR) 和 95% 置信区间 (CI)。 SGLT2抑制剂降低了所有KDIGO的复合肾脏结局（HR [95% CI]：低0.48 [0.32-0.71]，中0.60 [0.39-0.93]，高0.59 [0.47-0.74]，极高0.59 [0.49-0.72] ）和 UACR（HR [95% CI]：<30 mg/g 0.62 [0.50-0.78]，≥30 ≤300 mg/g 0.80 [0.67-0.96]，>300 mg/g 0.61 [0.52-0.73]）组，没有证据表明组之间存在异质性。局限性：低风险群体中没有糖尿病的受试者比例很小，并且缺乏复合结果的标准化。结论：SGLT2 抑制剂在 KDIGO 类别和 UACR 水平范围内持续降低肾脏结局。版权所有 © 2024 美国肾脏病学会...