Abstract: FR-PO749
Impact of SGLT2 Inhibitors on Cardiovascular and Renal Outcomes According to Baseline Renal Function: A Systematic Review and Meta-Analysis
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Mavrakanas, Thomas, McGill University Health Centre, Montreal, Quebec, Canada
- Tsoukas, Michael A., McGill University Health Centre, Montreal, Quebec, Canada
- Sharma, Abhinav, McGill University Health Centre, Montreal, Quebec, Canada
- Gariani, Karim, Hopitaux Universitaires Geneve, Geneve, Genève, Switzerland
Background
The effect of sodium-glucose co-transporter-2 (SGLT-2) inhibitors on cardiovascular and renal outcomes has not been specifically examined across baseline kidney function groups in a meta-analysis including the most recent trials. We conducted a systematic review and meta-analysis of randomized control trials (RCTs) with SGLT-2 inhibitors in patients with and without CKD.
Methods
We performed a PubMed/Medline search of randomized, placebo-controlled, event-driven outcome trials of SGLT-2 inhibitors versus active or placebo control in patients with and without diabetes from inception to February 1, 2022. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73m2. The primary outcome was cardiovascular death. Secondary outcomes included hospitalization for heart failure, major adverse cardiovascular events (MACE), progression to kidney failure, and all-cause mortality. The relative risk (RR) was estimated using a random-effects model.
Results
Eleven RCTs were identified and included in this meta-analysis (77541 patients, including 28515 patients with CKD). Use of an SGLT-2 inhibitor was associated with a lower incidence of cardiovascular death in patients with CKD, compared with placebo: RR 0.87 (95% CI 0.79-0.95). Use of an SGLT-2 inhibitor was associated with a lower incidence of heart failure in patients with CKD, compared with placebo: RR 0.65 (95% CI 0.59-0.70). Risk reduction with SGLT-2 inhibitors was more important among patients with CKD compared with patients without CKD (p for interaction 0.03). SGLT-2 inhibitors were associated with a lower incidence of CKD progression among patients with pre-existing CKD, compared with placebo: RR 0.74 (95% CI 0.63-0.88). SGLT-2 inhibitors were also associated with a lower incidence of MACE and death from any cause among patients with CKD, compared with placebo.
Conclusion
SGLT-2 inhibitors offer strong protection against cardiovascular and renal outcomes in patients with CKD. These results strongly advocate in favor of using these agents in patients with CKD.
Funding
- Government Support – Non-U.S.