SGLT2 inhibitors safely reduce the risk of kidney disease progression, acute kidney injury, cardiovascular death, and hospitalization for heart failure (HF) in patients with chronic kidney disease (CKD) or HF, irrespective of diabetes status, according to results from the EMPA-KIDNEY meta-analysis presented Nov. 6 during AHA 2022 and simultaneously published in the New England Journal of Medicine.

Researchers conducted a systematic review and meta-analysis of 13 large, double-blind, placebo-controlled, SGLT2 inhibitor trials lasting at least six months in duration and encompassing a total of 90,409 patients. The main efficacy outcomes were kidney disease progression, acute kidney injury, and a composite of cardiovascular death or hospitalization for HF. Other outcomes were death from cardiovascular and noncardiovascular disease considered separately, and the main safety outcomes were ketoacidosis and lower limb amputation.

Overall results found the proportional benefits of SGLT2 inhibitors were similar in patients with and without diabetes and appeared to be evident across the wide range of kidney function studied, according to researchers. Additionally, the proportional benefits on kidney disease progression were similar across the range of primary kidney diagnoses in the trials involving patients with CKD. Researchers also noted, that "based on estimates of absolute effects, the absolute benefits of SGLT2 inhibition outweighed any serious hazards of ketoacidosis or amputation."

"In addition to the established cardiovascular benefits of SGLT2 inhibitors, the randomized data support their use for modifying risk of kidney disease progression and acute kidney injury, not only in patients with type 2 diabetes at high cardiovascular risk, but also in patients with CKD or HF irrespective of diabetes status, primary kidney disease, or kidney function," said David Preiss, MD, et al.

Keywords: AHA Annual Scientific Sessions, AHA22, Renal Insufficiency, Chronic, Kidney, Glucosides, Benzhydryl Compounds

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