Abstract: SA-PO1148
SGLT2 Inhibitors Rather Than GLP-1 Receptor Agonists Lower the Risk of Kidney Failure: A Systematic Review and Network Meta-Analysis
Session Information
- CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Katkam, Niharika, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Akramimoghadam, Farideh, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Babu, Poorvika, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Howes, Lydia A, University of Utah Health, Salt Lake City, Utah, United States
- Sathapanasiri, Thipsukhon, University of Utah Health, Salt Lake City, Utah, United States
- Rashid, Muhammed, University of Utah Health, Salt Lake City, Utah, United States
- Hartsell, Sydney Elizabeth, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Boucher, Robert E., Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Sarwal, Amara, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- McFarland, Mary M., University of Utah Health, Salt Lake City, Utah, United States
- Chaiyakunapruk, Nathorn, University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
Background
While a broad kidney composite of >50% decline in eGFR, kidney failure (defined as sustained eGFR <15 ml/min/1.73 m2 or need for dialysis or transplantation) or renal death is commonly used in clinical trials, kidney failure per se represents the ultimate kidney hard endpoint. Therefore, the comparative effects of SGLT2i vs GLP-1RA on the kidney failure outcome need to be studied.
Methods
A systematic search between 2015-2025 was conducted in PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov. Randomized controlled trials (RCTs) comparing SGLT2i or non-exendin-4 GLP-1RA (liraglutide, dulaglutide and semaglutide) vs placebo in adults were considered. Eligible trials reported kidney failure outcomes, including sustained stage 5 CKD or ESKD (initiation of dialysis or transplant). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Treatments were ranked according to surface under the cumulative ranking curve (SUCRA) values.
Results
We included 11 RCTs with 28,784 participants (mean age 65.5 ± 2.6 years, mean follow-up 149.92 weeks). As shown in fig.1 compared to placebo, SGLT2i empagliflozin, dapagliflozin, and canagliflozin significantly lowered the risk of kidney failure. On the other hand, semaglutide, dulaglutide and liraglutide showed no apparent difference compared to placebo. No evidence of inconsistency (p = 0.135) or publication bias was detected.
Conclusion
SGLT2i reduced the risk of kidney failure with empagliflozin, dapagliflozin, and canagliflozin ranking highest, supporting their preferential use in persons at high risk of kidney failure
| Intervention | RR | 95% CI | p-value | SUCRA |
| SGLT2i | ||||
| Empagliflozin | 0.46 | 0.22-0.98 | 0.045 | 82.2 |
| Sotagliflozin | 0.32 | 0.03-3.11 | 0.329 | 76 |
| Dapagliflozin | 0.68 | 0.53-0.86 | <0.001 | 63.2 |
| Canagliflozin | 0.70 | 0.55-0.88 | 0.003 | 58.6 |
| GLP-1RA | ||||
| Dulaglutide | 0.72 | 0.46-1.14 | 0.164 | 52.1 |
| Semaglutide | 0.85 | 0.71-1.03 | 0.089 | 31.2 |
| Liraglutide | 0.88 | 0.61-1.25 | 0.466 | 28.8 |
Funding
- NIDDK Support